Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 412
Country/Region: Zambia
Year: 2008
Main Partner: World Vision
Main Partner Program: NA
Organizational Type: FBO
Funding Agency: USAID
Total Funding: $17,425,329

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $2,408,152

RAPIDS, which undertakes care and support activities in 49 of the 72 districts in Zambia, is a consortium of

six organizations: World Vision, Africare, CARE, CRS, The Salvation Army, and the Expanded Church

Response (ECR), as well as other community-based organization (CBO) and faith-based organization

(FBO) local partners. RAPIDS uses a household approach which creates a basis for extending care and

support to youth, OVC, and PLWHA within the context of needs and priorities identified at a household

level. RAPIDS will support the Zambia National HIV/AIDS Prevention Strategy and campaigns, and will

work with PEPFAR funds to reduce HIV transmission accordingly, within its project mandate, and to the

extent its resources permit

In FY 2007, RAPIDS expects to reach over 36,396 youth with Abstinence and Being Faithful for Youth

(ABY) messaging while over 6,000 will receive training in AB-related activities using a six module training

program (required before youth are eligible for livelihood activities). Of the total number of youth to be

reached, over 4,751 youth will participate in livelihood training. In FY 2008, RAPIDS plans to reach 45,437

youth directly with ABY interventions. RAPIDS will place additional emphasis on collection and analysis of

bio-marker information (teen pregnancy, STI and HIV infection rates) to document the successes, strengths

and weaknesses of its ABY approach.

The overall ABY strategy of the program will be modified using the lessons and recommendations from the

mid-term evaluation conducted during FY 2007 in order that it is more evidence based. RAPIDS will train

local pastors, teachers, and peer educators to promote Abstinence and Be faithful (AB) messages at

community meetings, schools, church meetings, one to one counseling, sporting events, during visits to

HBC clients, and in work with youth. Faith and school leaders command a very important position of

respect in local communities; empowering them to reach youths is therefore a very effective strategy.

Through its small grants support, RAPIDS will support 35 small grants with a budget of $375,000 for ABY

and livelihood activities. Capacity development training in financial and project management will be

extended to these groups.

In FY 2008, RAPIDS will continue targeted prevention strategies to focus on boys/young men. This is in

view of the central role they play in courtship and HIV transmission, as well as in the empowerment of

women and reduction of gender based violence. Two thousand three hundred sixty five (2,365)

boys /young men will be trained in life skills with a focus on gender roles in order to counter stereotypes that

encourage risky sexual behaviors. RAPIDS will specifically encourage young men to form or participate in

existing support groups as allies in the reduction of violence against women and children and to get

involved in home-based care (HBC) work in order for them to assume a community caring role. In order to

assist youth with community care roles, training will be provided in basic counseling and psychosocial

support (PSS) so that they can provide counseling to their peers who might be going through trauma of

illness or loss of their parents. RAPIDS will contribute to the reduction in HIV transmission by promoting

abstinence among unmarried young people aged 10-24 years and faithfulness among young married

couples. Through the Youth Forum, RAPIDS will interface with GRZ to contribute to the National Youth

Policy field implementation and monitoring.

RAPIDS will sensitize ‘Gate Keepers' such as traditional leaders and traditional initiators to ensure that they

fully understand and appreciate their role in promoting AB among young people. In coordination with

national AB-related campaigns, messages and material and PEPFAR-funded HCP, RAPIDS will adapt and

distribute a variety of AB information, education, communication (IEC) materials. In addition, RAPIDS will

apply other strategies for dissemination of information such as drama campaigns, sport, radio, and music

festivals. In monitoring its youth support activities, RAPIDS will continue to refine and adapt its M&E tools

to align with overall PEPFAR guidelines and indicators as well as the UNAIDS "Three Ones". RAPIDS will

support consortium members in developing ABY M&E systems capable of documenting interventions and

demonstrating impact. RAPIDS will encourage documentation of case studies/success stories at all levels.

RAPIDS will strengthen referral networks at district level, and will continue to work with Government of

Zambia (GRZ) structures such as District AIDS Task Forces (DATFs). The referral process shall involve

identification of key service providers, formalization of collaborative relationships, and follow-ups. RAPIDS'

partners and small grantees will greatly intensify efforts to identify and refer at-risk youth, to relevant

services such as VCT, sexually transmitted infections (STI) testing, and treatment to extend the reach and

impact of expanding HIV/AIDS mitigation activities. The community-based CT program will conduct

counseling and testing for youth.

RAPIDS will continue to support apprenticeships and internships through private-sector partnerships that

provide youth with valuable work experience and job opportunities. It is anticipated that 1500 youth will be

linked to apprentice and internship opportunities.

To prevent transactional sex, RAPIDS will enhance the nutritional status of youth and at-risk OVC by

providing life skills training including information and skills in good nutrition and food production appropriate

to climatic, environmental, and cultural conditions. Youth will be provided skills in food processing and

utilization. The life skills training will equip the target groups to identify, analyze, and deal with inequalities

and power imbalances between women/girls and men/boys in communities. The program will also work

with traditional initiators/leaders to eliminate harmful traditional and cultural practices which put youth at

high risk such as early initiation of sex, dry sex, sexual cleansing, and wife inheritance. In addition RAPIDS

will work to reduce transactional sex, a strategy commonly used by young women for coping with poverty,

by providing livelihood training and access to business start-ups. As part of HIV prevention, youth will be

educated on the link between alcohol and HIV/AIDS and advocacy efforts made to reduce intake of alcohol

among youth. In partnership with SFH, male circumcision will be promoted as a prevention method.

RAPIDS will form linkages with other USG funded programs and GRZ service providers to support youth

livelihoods programming, for economic empowerment of youth, and to enhance access to HIV/AIDS

information. RAPIDS will work with Micro-Finance Institutions to disburse loans for youth small-enterprise

activities. RAPIDS will also work with other organizations including other USG funded partners such as

Land-O-Lakes and PROFIT project to develop micro-finance options for youth.

RAPIDS main approach to promotion of sustainability is through mobilization of communities nationwide to

take a lead role in the response to HIV/AIDS in Zambia. To further the sustainability of current grassroots

efforts, RAPIDS provides training to CBOs and FBOs designed to improve their management skills and

Activity Narrative: ability to access existing HIV/AIDS resource streams. RAPIDS technical and material support for the

development of prevention activities include equipping HIV educators within FBO/CBO institutions with a

"Training of Trainers" program designed to help them provide further training to supervisors, peer educators,

and staff within their respective institutions and organizations.

In addition RAPIDS is providing extensive values-based life skills training and abstinence promotion for

youth including a practical component where special workshops are arranged to train youth in agricultural

skills, crafts such as pottery and basket weaving, home economics, cooking and gardening, and other such

vocational skills as may be appropriate to each setting. The youth are linked to private businesses to

explore the possibility of workplace-type trainings and with NGOs and/or agricultural extension agents for

their assistance in training youth in farming practices and other subjects for sustainability.

The RAPIDS small grants program equips CBOs/FBOs to respond to HIV/AIDS in their communities more

effectively through mentorship and training, and helps to sustain the RAPIDS approach to HIV/AIDS

mitigation.

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

Funding for Care: Adult Care and Support (HBHC): $5,392,962

This activity is connected with other RAPIDS activities including HVAB, HTXS, HVCT, PMTCT and HKID,

especially new NPI HBHC partners in need of mentoring, such as Kara/FBR and Nazarene Compassionate

Ministries. New activities and emphases include: continued strengthening of pediatric care training for

caregivers and closer linkages to pediatric ART sites with emphasis on referral of HIV-exposed infants for

early diagnosis using Polymerase Chain Reaction (PCR) technology, to decrease HIV-related infant

mortality. RAPIDS will also work closely with therapeutic feeding for malnourished PLWHA and with infant

and young child nutrition activities. RAPIDS will also build on extensive malaria control activities begun

during FY 2007 to reduce malaria-related illness in PLWHA. In FY 2008, RAPIDS will link closely to

hospices and refer clients for hospice. RAPIDS will ramp up routine Cotrimoxazole prophylaxis for all HIV-

infected clients possible . Lastly, RAPIDS will increase the emphasis on sustainability and capacity building

in the last year of PEPFAR.

RAPIDS, which undertakes care and support activities in 49 of the 72 districts in Zambia, is a consortium of

six organizations: World Vision, Africare, CARE, CRS, The Salvation Army, and Expanded Church

Response (ECR), as well as community-based organization (CBO) and faith-based organization (FBO) local

partners. RAPIDS uses a household approach to extend care and support to youth, OVC, and PLWHA

within the context of household needs and priorities identified.

In FY 2008, RAPIDS plans to provide home-based palliative care and support to 51,855 PLWHA.

To ensure quality service delivery, RAPIDS will build the capacity of clients, their families, caregivers, and

their nurse supervisors through training, provision of material support, and technical assistance. Quality

Assurance (QA) will be a priority. QA mechanisms will include caregiver checklists, patient chart review, and

monthly care improvement meetings between caregivers and nurse supervisors.

Palliative care services will include: education to improve knowledge, attitudes, and practices on HIV/AIDS;

drugs for opportunistic infection (OI) treatment; psychosocial and spiritual support; infection prevention

through provision of medical equipment; symptom/pain assessment and management; and patient/family

education and counseling. Case coordination will include community-based "Care Coordinators" to refer

clients to various service providers. In its work with PLWHA, RAPIDS will support Prevention for Positives

programming. For example, RAPIDS will counsel PLWHA on behavior change (reduction in alcohol intake

to decrease risky sexual behavior), nutrition, and provide appropriate, factual information Other Prevention

strategies. RAPIDS will also provide PMTCT sites with coordinates of its home based care programs, to

which PMTCT providers will refer PMTCT clients for follow up in the community from birth through at least

six months to support breast-feeding and timely weaning using appropriate weaning and complementary

foods. RAPIDS will also refer female PLWHA who are (or may be) pregnant to PMTCT.

In addition, RAPIDS will continue to strongly advocate to the Government of Zambia (GRZ) for a home

based palliative care policy and delivery framework in Zambia. RAPIDS will support efforts by AIHA-PCAZ

and SHARe to advocate for, promote, and disseminate policies and guidelines favorable to comprehensive

palliative care.

RAPIDS will continue to work with SUCCESS and other HBHC programs. and link them to livelihood

initiatives. These linkages will contribute to the overall goal of the program. FY 2008 will see an expansion

of interventions and linkages in HBHC and move towards a full continuum of care. 2007.

RAPIDS plans to administer some of HBHC activities through 35 sub-grants with a budget of $510,000 to

strengthen HBHC community based groups. To improve quality of care, RAPIDS will, through private and

corporate donations, provide nurse and volunteer caregiver kits. While continuing to solicit in-kind

donations of kits, RAPIDS will also explore more sustainable means to produce and re-supply kids in

Zambia using local products, providers and facilities.

Client will receive kits as prescribed by the HIV/AIDS National Guidelines on "minimum standards of care."

RAPIDS will provide volunteers with non-cash incentives (‘tools for work') through consortium public/private

partnerships with USA corporations Gifts-In-Kind (GIK) programs. Such items will include raincoats, bags,

shoes and bicycles. RAPIDS will intensify "care for caregivers" interventions to ensure that caregivers meet

their basic needs while continuing to support PLWHA.

RAPIDS will work with the National Malaria Control Center, PATH, PMI, and other stakeholders to promote

use of Insecticide Treated Bed Nets (ITNs). RAPIDS will try to secure a significant number of ITNs and

more may be procured through GIK. PEPFAR funds will support ITN warehousing, internal distribution,

transport, training, awareness raising, and monitoring by caregivers.

RAPIDS will help develop and implement of the palliative care pain relief strategy document. Palliative care

and management of simple and moderate pain, endorsed by World Health Organization (WHO) will be a

major intervention, as part of the minimum standard of care for PLWHA for regular prophylactic use of

simple to moderate pain management drugs.

RAPIDS will provide targeted nutritional supplements for PLWHA according to national and PEPFAR

Guidance. RAPIDS will participate in and support efforts by FANTA and IYCN to determine nutritional

needs, and promote better nutritional assessment, counseling, and support in all palliative care activities in

Zambia, in close coordination with GRZ agencies such as the National Food and Nutrition Commission

(NFNC), NAC and the MOH Nutrition focal persons. PLWHA will receive nutrition counseling and education.

Seed distribution coverage will expand in FY 2008. In general, FY 2008 RAPIDS will intensify formation of

Positive Living Groups with livelihood options.

RAPIDS will continue to train caregivers and HBHC health providers on combating stigma and

discrimination by increasing understanding of the disease and the challenges faced by PLWHA; encourage

participation of PLWHA in the design and implementation of projects; and promote the involvement of youth,

particularly males, as caregivers. RAPIDS will also mainstream gender equality in its care and support

activities. RAPIDS will support gender equity efforts in palliative care led by SHARe, for example, to reduce

violence against women related to HIV diagnosis or discordant HIV results.

Activity Narrative: RAPIDS provides capacity building to community committees currently working on home-based care and

support activities, and is scaling-up successful support groups and youth groups, as well as broadening the

anti-stigma message.

RAPIDS will work through communities and mobilizes community committees as the primary mechanism for

providing care and support to PLWHA and vulnerable households. These community committees will draw

membership from a broad spectrum of community stakeholders to ensure multisectoral representation and

a holistic and coordinated response to caring for the community. RAPIDS will mobilize communities to take

the lead in mitigating the impact of HIV/AIDS as the key to long-term sustainability in the response to

HIV/AIDS.

RAPIDS will train CBOs and FBOs to not only provide care and support to PLWHA, including children and

adolescents, but to train in such critical areas as advocacy and paralegal support. RAPIDS will facilitate

linkages between communities and other service providers. RAPIDS will provide training to local

community-based organizations to improve management skills and the ability to access existing HIV/AIDS

resource streams. RAPIDS has designed and will implement a "Training of Trainers" program to equip

FBO/CBO HIV/AIDS service providers with skills to ensure long-term scale-up of training of supervisors,

peer educators, and staff within their respective institutions and organizations.

RAPIDS HBHC activities are integrated into existing government and NGO district structures and comply

with the "Three Ones". RAPIDS will also contribute to the sustainability of the HIV/AIDS response in its

work by solidifying and reinforcing critical networks and alliances; sharing lessons learned and best

practices; leveraging resources; forming partnerships; ensuring that duplication is not occurring, and

advocating for the promotion of improved policy in home-based and palliative care support.

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

Funding for Care: Orphans and Vulnerable Children (HKID): $7,198,487

This activity is connected with other RAPIDS activity areas including HVAB, HTXS, HVCT, and HBHC, as

well as with other orphan and vulnerable children (OVC) activities, ART, PMTCT, and CT. New activities

and emphases include: continued strengthening of pediatric care training for OVC caregivers, and closer

linkages to pediatric ART sites with emphasis on collection of Dried Blood Spot (DBS) samples and/or

referral of HIV-exposed infants for early diagnosis where available. RAPIDS will work more closely with

therapeutic feeding for malnourished PLWHA, and with infant and young child nutrition activities. RAPIDS

will also build on extensive malaria control activities begun during FY 2007 to reduce malaria-related illness

and death in OVC. RAPIDS will ramp up routine Cotrimoxazole prophylaxis for HIV-infected OVC. Lastly,

RAPIDS will increase the emphasis on sustainability and capacity building in the last year of PEPFAR.

RAPIDS, a consortium of six organizations (including: World Vision, Africare, CARE, CRS, The Salvation

Army, and the Expanded Church Response) as well as other faith (FBO) or community-based organization

(CBO) local partners, undertakes care and support activities in 49 of the 72 districts in Zambia. RAPIDS

uses a household approach, creating a basis for supporting youth, OVC, and PLWHA within the context of

the household.

In FY 2008, RAPIDS will continue to scale up care and support to OVC. In FY 2007, RAPIDS expects to

reach 196,595 OVC, while in FY 2008, the program plans to reach 199,185 OVC and train 7,967 caregivers.

RAPIDS will apply a network approach at national, provincial, and district levels to link and coordinate

efforts with other USG and GRZ prevention, care, and treatment efforts. Caregivers will practice quality

care and psychosocial support, legal and social protection of OVC, based on needs identified during home

visits. RAPIDS will intensify care of OVC under five years of age through Child Health Week, i.e.,

deworming children with mebendazole, and supplementation of Vitamin A as well as through ITN

distribution. Caregivers will facilitate referrals of potential HIV+ infants and children for clinical care at

pediatric ART sites. Children born to mothers in PMTCT programs will receive follow up through home

visits and be referred to health services. Parents will be referred for counseling and adherence support.

RAPIDS will provide PMTCT sites with coordinates of its OVC care and support programs, to which PMTCT

providers will refer their clients for follow up in the community from birth through at least six months to

support breast-feeding and timely weaning using appropriate weaning and complementary foods. RAPIDS

will also refer any female OVC of child bearing age who are (or who may be) pregnant to PMTCT.

Counseling and testing of children with a community-based approach will continue through mobile units and

family-based household counseling and testing, according to national guidelines, by trained counselors.

RAPIDS will help test infants by collecting DBS specimens and sending them to PCR centers.

District RAPIDS staff will facilitate the provision of care and support through mobilized community groups.

RAPIDS will enhance the capacity of FBOs/CBOs by providing up to approximately 31 sub-grants valued at

a total of about $300,000 (though the amounts will vary by partner) to expand OVC outreach. Partnerships

with FBOs/CBOs will help train caregivers, peer educators, and clergy in OVC care and support.

RAPIDS will provide volunteer caregivers with non-cash incentives and tools for work (bicycles, clothes,

shoes, umbrellas, apparel, Insecticide Treated BedNets (ITNs), and care kits). Enhancement of access to

education for the children will include offsetting fees; providing school uniforms, shoes, and books; teacher

capacity building; and rehabilitating community schools' structures. RAPIDS will collaborate and coordinate

with CHANGES II on scholarships for secondary school children.

RAPIDS will remain a key member of the National AIDS Council Impact Mitigation Thematic Group and the

National OVC Steering Committee. RAPIDS will support a policy advisor at the Ministry of Youth, Sport and

Child Development, to help disseminate and operationalize the National Child Policy (approved by Cabinet

and launched in June 2006) and the GRZ Mid-Term OVC Plan 2005-2007 and contribute to the

development of the National Plan of Action for Children. RAPIDS staff, members of district structures, and

the media, will identify advocacy issues and a process for policy formulation. RAPIDS will continue to

support the "Populations Impacted by HIV/AIDS Media Awards," held annually for best media coverage on

issues of HIV/AIDS.

RAPIDS will continue to provide non-clinical support to Family Support Units (FSUs) which target children

living with HIV/AIDS (CLWHA) next to hospitals and health centers in Ndola, Lusaka, Livingstone, and a

hospital in the northern region, to be identified during FY 2007. RAPIDS will support quality psychosocial

pediatric support to CLWHA and their parents/guardians, specializing in play therapy. Involving HIV+

children in play activities will reduce stigma and discrimination. RAPIDS will support "non-medical" services

of the FSUs, linking children to ART services and supporting ART adherence. CDC partners or ZPCT will

support technical/clinical aspects of VCT clinical training, equipment, and supplies.

Through its collaboration with the Malaria Control Centre and PMI, RAPIDS will provide ITNs to prevent

malaria accompanied by IEC material and malaria education in partnership with the Malaria Focal Point

Persons of the MOH/DHMT. To support OVC livelihoods and food security, RAPIDS will continue to

provide agricultural inputs, seed, livestock, and small scale irrigation equipment to OVC households and

caregivers, accompanied by training in sustainable agricultural practices, food processing, and utilization.

RAPIDS will support alternative livelihood options, such as small business development, linkages to micro-

finance institutions, and income generating activities for households in urban areas, and provide appropriate

training. RAPIDS will provide nutrition training to 16,000 severely vulnerable households. Gender

mainstreaming and gender equity will be ensured. For example, linkages will be formed with the Victims

Support Units (VSU) of the Zambia Police and hospitals/health centre paralegal support centers in order to

deal with gender-based violence (GBV) cases and community sensitization and awareness deliberately

involving local leadership, to protect the vulnerable girl child.

USG agencies and 27 OVC partners will continue to operationalize the joint strategic plan to align activities

and reach targets with greater synergy and coordination through the OVC Forum Technical Advisor and

provide support to the Ministry of Community Development and Social Services. RAPIDS will link OVC with

clinics for food and nutrition support according to PEPFAR and national guidelines. Infant young child

feeding will also be encouraged and private food processors engaged. RAPIDS will participate in and

support efforts by FANTA and IYCN projects to determine OVC nutritional needs, and promote better

nutritional assessment, counseling, and support in all OVC care and support activities in Zambia. This will

be in close coordination with GRZ agencies such as the National Food and Nutrition Commission (NFNC),

Activity Narrative: NAC and the MOH Nutrition focal persons.

RAPIDS will mobilize communities as the key to long-term sustainability in the response to HIV/AIDS in

Zambia. The training of caregivers will ensure capacity of the community to serve the households. Training

of community committee members contributes towards sustainability. The caregivers, as well as the

members of the committees, work as volunteers and do not depend on external support. Livelihood options

for the households and the caregivers will contribute towards better life for OVC.

Links with government support such as Pediatric ART (P-ART) through the hospitals and government

structures at district level, District AIDS task forces (DATFs) are included in RAPIDS. This collaboration is

part of the exit strategy to ensure continued community support beyond the life of the program as well as

contribute to the UNAIDS-endorsed Three Ones (One coordinating mechanism, One framework, and One

M&E system).

To further the sustainability of local organizations efforts, RAPIDS provides training and sub-grants to CBOs

and FBOs supporting OVC. The training will improve programmatic and management skills and the

provision of quality services and access to other existing HIV/AIDS resource streams. RAPIDS technical

and material support for the development of prevention activities includes equipping HIV/AIDS educators

within FBO/CBO institutions with a life skills "training of trainers" program to help provide further training to

supervisors, peer educators, and staff within their respective institutions and organizations.

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

Funding for Testing: HIV Testing and Counseling (HVCT): $858,028

This activity is integrally connected with other RAPIDS activity areas including HVAB, HTXS, HKID, and

HBHC. New activities and emphases include: more direct CT than in the past; a shift to finger-stick protocol

recently approved by the Government of Zambia (GRZ) Ministry of Health; and support for pediatric HIV

diagnosis via collection of Dried Blood Spots (DBS) for analysis where possible. Lastly, RAPIDS will

increase the emphasis on sustainability and capacity building in the last year of PEPFAR. The most lasting

gains in sustainability will be in terms of: organizational sustainability (organizations will continue operations

after PEPFAR); and sustainability of services (organizations will continue services as resources permit).

The most difficult to achieve will be financial sustainability (maintaining the same level of funding).

RAPIDS, which undertakes care and support activities in 49 of the 72 districts in Zambia, is a consortium of

six international and local organizations: World Vision, Africare, CARE, CRS, The Salvation Army, and the

Expanded Church Response (ECR), as well as other CBO and FBO local partners. RAPIDS uses a

household approach which creates a basis for extending care and support to youth, OVC, and PLWHA

within the context of needs and priorities identified at the household level.

RAPIDS will continue to integrate CT services into all its care and support activities targeting youth,

PLWHA, children living with HIV/AIDS (CLWHA), and OVC. RAPIDS CT will target providing VCT to 18,653

clients in FY 2008. RAPIDS expects to have reached 11,661 individuals in FY 2007, and will increase that

number significantly in FY 2008 through the shift to finger-stick methods, the provision of additional training,

and mobilization of its HBC and OVC volunteer caregivers, youth networks, and facilitation for on-site CT

services.

RAPIDS will provide training to 118 health care providers who are part of the home-based care programs in

counseling and testing. RAPIDS will purchase and distribute testing kits to trained health care providers

and where these kits already exist, health providers will be linked to the local district level supply chain of

VCT kits. The health care providers will conduct CT for clients referred by lay counselors as well as through

mobile outreach services in the communities. RAPIDS will also build the capacity of trained counselors

under the Family Support Units in using rapid testing kits so that FSUs are able to expand their outreach

services into the communities. The trained health care providers will also train caregivers as lay counselors

using national and international standards in order for them to provide counseling at household level and

refer clients to both mobile and static CT services for professional counseling and testing. Strong linkages

will be made with GRZ health centers at district level to ensure clients are provided with services through

follow-up and feedback using the government recommended referral system.

In addition, RAPIDS will seek creative and practical ways to connect communities to CT by sensitizing them

to the importance of CT. RAPIDS' focus shall be on home/family- based testing. Through the household or

family centered approach, interventions will be conducted reaching a target population which includes OVC,

youth, and home-based care (HBC) clients and their family members. RAPIDS will work with existing

partners currently providing CT services in order to scale-up their activities. In addition to direct counseling

and testing, RAPIDS will continue with its CT referrals and will develop a system to link post-test clients to

prevention, care, and ART services. Those that are HIV positive will be linked to PLWHA support groups or

encouraged to create new groups. CT promotional materials developed by other USG programs such as

HCP will be accessed and distributed. All six RAPIDS partners will implement CT activities to ensure that

RAPIDS reaches its CT targets.

To promote operational linkages and enhance the network model approach, RAPIDS will forge partnerships

with other USG supported initiatives that provide CT such as Zambia Prevention Care & Treatment (ZPCT),

AIDS Relief, and Centre for Infectious Disease Research in Zambia (CIDRZ), Corridors of Hope II, and PSI

New Start. Each of the RAPIDS consortium partners, and some of its FBO/CBO sub-grantees, will include

direct provision and/or support of CT in OVC, youth, and HBC programming. RAPIDS will follow GRZ

guidelines on lower age limits for providing CT for youth with or without parental advice and consent.

To ensure that men and women adults, and male and female youth have equal access to CT, RAPIDS will

plan with a deliberate focus on gender-sensitive issues. RAPIDS will concentrate on reducing barriers to

CT that men and women face, as well as concerns of single and married persons, with attention to the risk

of violence for married women who seek CT without advance knowledge or consent of their spouse.

RAPIDS will target youth-at-risk and children in HIV/AIDS affected families with strategies that respond to

the needs of each age group within their family and social context. RAPIDS will work with FBOs and faith

leaders to encourage congregants to undergo CT , reduce stigma and discrimination through sensitization

activities on the importance of CT, and support mobile testing vans to conduct CT at churches especially

during religious celebrations and other church activities.

RAPIDS is ensuring that the program is integrated into existing district structures including the health

facilities, and is contributing to build the capacity of these structures to ensure sustainability of CT services

and demand beyond the life of the program. RAPIDS will also contribute to the sustainability of the

HIV/AIDS response by solidifying and reinforcing critical networks and alliances; sharing lessons learned

and best practices; leveraging resources; forming partnerships; ensuring that duplication is not occurring;

and advocating for the promotion of improved CT support.

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

Funding for Treatment: Adult Treatment (HTXS): $1,567,700

This ART adherence support activity is connected with other RAPIDS activity areas including HVAB, HVCT,

HKID, and HBHC, as well as CRS/SUCCESS II HBHC and HTXS, Health Communication Partnership

(HCP) HBHC and HTXS, ZPCT HTXS, AIDSRelief HTXS, CIDRZ HTXS and Society for Family Health

(SFH) HBHC. RAPIDS does not provide ART directly, rather, it supports adherence by clients of other

direct ART providers. New ART adherence activities and emphases include: continued strengthening of

pediatric care training for OVC and HBC caregivers, and closer linkages to pediatric ART sites with

emphasis on referral of HIV-exposed infants for early diagnosis where available. RAPIDS will also work

more closely with therapeutic feeding for malnourished PLWHA, and with infant and young child nutrition

activities, to improve nutrition status in treatment/care clients.

Though its adherence support efforts, RAPIDS will help the GRZ and USG Zambia to: support an increase

in the number of ART patients and sites; and support ART quality improvement and M&E. RAPIDS will also

establish links to ART Centers of Excellence as a client referral destination and utilize the ART Centers of

Excellence as a source of learning for adults and pediatric ART. RAPIDS will provide particular Adherence

Support in remote, rural areas of Zambia through its vast community based volunteer network nation-wide.

These volunteers will direct clients to ART sites. In cases where transport is a barrier, RAPIDS will assist

with client transport. RAPIDS will facilitate where and when possible in bringing ART closer to clients, for

example, through support of ART in hospice or other community settings.

RAPIDS also will build on extensive malaria control activities begun during COP FY 2007 to reduce malaria-

related illness in ART patients. RAPIDS will support routine Cotrimoxazole prophylaxis for all PLWHA.

Lastly, RAPIDS will increase the emphasis on sustainability and capacity building in the last year of

PEPFAR. The most lasting gains in sustainability will be in terms of: organizational sustainability

(organizations will continue operations after PEPFAR); and sustainability of services (organizations will

continue services as resources permit).

RAPIDS, which undertakes care and support activities in 49 of the 72 districts in Zambia, is a consortium of

six international and local organizations: World Vision, Africare, CARE, CRS, The Salvation Army, and

Expanded Church Response (ECR), as well as other CBO and FBO local partners. RAPIDS will continue to

be a leading provider of community-based ART referrals and ART adherence in FY 2008. RAPIDS will

reach 11,815 beneficiaries (out of the total 48,115 being directly reached with general home-based palliative

care (HBHC)) with ART access and adherence support services.

RAPIDS will continue and strengthen non-clinical support to four Family Support Units (FSUs) in Lusaka,

Livingstone, Ndola, and another to be started in FY 2007. RAPIDS partners will build their work on proven

integrated methods to encourage parents and guardians to seek CT for children; provide community-based

support for ART adherence; provide psychosocial support for children living with HIV/AIDS (CLWHAs) and

their family members; address stigma and discrimination in the community; and deal with the specific needs

of family caregivers, families where both parents and children are on ART, and children in need of

counseling. Outreach into communities will be conducted to encourage people to attend or support families

with children on ART at clinics as this is where service provision for pediatric ART (P-ART) is almost

exclusively provided.

During FY 2008, RAPIDS will continue to collaborate with government and other USG funded ART projects

such as ZPCT, AIDS-Relief and CIDRZ. The goal will be to increase access to ART. Strengthened P-ART

referral systems will ensure that pediatric PLWHA from the HBHC program are linked to ART services.

RAPIDS will collaborate with AIDS-Relief and CIDRZ to identify and refer HIV+ children, where P-ART

services are available. These interventions will include increase awareness, promote early CT, support

parents managing P-ART for their children, promote issues related to adherence, and enhance

psychosocial support for P-ART clients.

These services will link to clinic-based services in specific areas where P-ART is available. The RAPIDS

consortium will also strengthen the skills and knowledge of HBHC providers through training in the provision

of care and support for CLWHA. Moreover, RAPIDS is working to ensure that PLWHA under its coverage

benefit fully from the GRZ scale-up of ART and expanded palliative care services. These benefits will

mainly be ensured through the strengthening of the established system of referrals and linkages with health

facilities and regular follow-up support.

RAPIDS will continue to train home-based care (HBC) caregivers and medical personnel in ART adherence,

prevention of resistance to ART, monitoring of side effects, and management of pain and basic clinical

management of Opportunistic Infections (OIs). Other activities will include: education on prevention of re-

infection especially for PLWHA on ART treatment; training and follow-up on ART adherence; provision of

mebendazole and vitamin A supplementation in collaboration with the MOH; and stronger linkages with

health systems for clinical care and ART. RAPIDS will also increase access to ART by providing support for

laboratory investigations when needed, and will fund transportation for patients who are unable to access

ART due to lack of transportation.

RAPIDS will provide targeted, time-limited nutritional supplements for PLWHA on ART according to

PEPFAR and GRZ guidelines, such as "Ready-to-use therapeutic foods" (RUTF) for severely malnourished

patients in readiness for ART treatment. Infants born from clients in PMTCT programs will be identified.

Children and pregnant/lactating women will receive nutrition assessment, counseling and support.

RAPIDS will intensify the community-based adherence support and care for those on ART through

conducting regular follow-ups and home visits by caregivers and Positive Living adherence supporters,

providing psychosocial and spiritual support, nutrition counseling, education, monitoring, and provision of

support for families with children and adults on ART through their existing HBHC programs in 49 districts.

RAPIDS will continue to strengthen linkage between HBHC and referral to nearby health facilities. In order

to do this, RAPIDS will significantly increase the number of HBHC coordinators and caregivers trained in

ART literacy and adherence, management of OIs and in referral networking. The program will include

identification of client transport options, linkages with HIV Counseling and Testing (CT) programs, and will

use a wraparound approach to access food supplementation.

RAPIDS will address gender concerns so that women and men are included in the ART program equitably.

Activity Narrative: This will also be reflected in the semi-annual reporting which will be disaggregated by sex. Like all RAPIDS

activities, ART adherence activities are designed to reduce stigma and discrimination through training of

caregivers and health providers in stigma reduction strategies.

Given the magnitude of the HIV/AIDS problem, it is evident that formal health care and support services

cannot cope with the numbers of individuals requiring assistance. Thus, the front-line response to

HIV/AIDS will have to come from communities themselves, as they increasingly take on the responsibility

for caring for their members and providing support to those on ART. Currently, RAPIDS mobilizes

community committees as the primary mechanism for providing care and support to OVC, PLWHA, youth,

and vulnerable households. These community committees draw their membership from a broad spectrum

of community stakeholders in an effort to ensure multi-sectoral representation and a holistic and

coordinated response. RAPIDS is achieving significant momentum in mobilizing communities and ensuring

that communities take the lead in mitigating the impact of HIV/AIDS and sees this as the key to long-term

sustainability in the response to HIV/AIDS in Zambia.

To further the sustainability of current grassroots efforts, RAPIDS provides training to CBOs and FBOs to

not only provide care and support to PLWHA, including children and adolescents, but also includes training

in such critical areas as advocacy and paralegal support. In addition to ensuring that communities

maximize the use of available resources, RAPIDS has created linkages to other resources in the

communities and provides training that is designed to improve management skills and the ability to access

existing HIV/AIDS resource streams.

RAPIDS is ensuring that the program is integrated into existing district structures, both government and

NGOs, and is contributing to building the capacity of these structures to ensure sustainability beyond the life

of the program. RAPIDS will also contribute to the sustainability of the HIV/AIDS response in its work to

solidify and reinforce critical networks and alliances, share lessons learned and best practices, leverage

resources, form partnerships, ensure that duplication is not occurring and advocate for the promotion of

improved policy in the core RAPIDS program areas.

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

Subpartners Total: $6,849,024
Africare: $1,744,756
Catholic Relief Services: $2,551,421
Expanded Church Response: $532,475
Salvation Army: $844,819
CARE International: $1,175,553