Preliminary work from an assessment conducted in collaboration with the University Teaching Hospital

(UTH) and University of Miami show promising results that with proper techniques couples can talk about

sex and build confidence in encouraging one another to engage in safe sexual practices. Concurrent

partnerships is the main driver of HIV infection in Zambia, like is the case in most countries in southern

Africa. It is critical to go beyond making sexually active youth and adults aware of condoms and where to

find them to engaging them in intensive conversations about safe sex and demonstrations on proper ways

to use condoms. These preliminary findings identified that most men in the study do not know how to

properly put on a condom and also have never used condoms due to fear of loosing erections. These

preliminary findings also show that when men and women have skills on how to use condoms they are

more confident and do use them.

Prevention continues to challenge in Southern Africa including Zambia where prevalence continues to

remain high. PLWA are living longer as the number of discordant couples increase. In attempt to diversify

and intensify prevention, UNZA will use the funds to scale up a prevention for psotives program to Western,

Southern and Eastern Provinces of Zambia. Funds will be used to scale up the program in these provinces

and provide build capacity of the PHOS to scale up the intervention in their districts and provide monitoring

supervison.

The School of Medicine at the University of Zambia is the only medical school in Zambia. Its first

admissions were in 1966 when Zambia's population stood at around 4 million. The school now serves a

population of about 12 million. After 40 years of post independence existence it has produced over 1600

graduates. The School has been operating below levels that would be required to produce adequate health

manpower for Zambia. This is basically owing to four factors namely: 1) Lack of adequate trained staff; 2)

Lack of teaching facilities, lecture rooms and laboratories; 3) Poor conditions of service; and 4) Lack of

student and staff houses.

The Government of the Republic of Zambia's vision of training 100 doctors per year as far back as 1970 has

not been realized. In the last 40 years, there has been no corresponding growth and development in

particular support areas such as laboratories and physical structures in spite the introduction of post

graduate programs in 1983 and more recently, the undergraduate programs in Pharmacy, Physiotherapy,

Biomedical Sciences and Environmental Health, which meant a treble in the number of students. The

programs aforementioned have not had additional teaching facilities developed in commensurate with a

seven fold increase in training programs at the school in the last 40 years. There has also been an

increased output of graduates from 14 medical students to well over a 100 health professionals per year but

without corresponding expansion of infrastructure and equipment. No new infrastructure was developed for

over 40 years. In 2006, as the School introduced a new Environment Health program, the first new building

in three decades was put up with assistance from the World Bank.

The school laboratories cater for not only medical students but other programs as well. The laboratories

meant to cater for 40 students are usually crammed up to unacceptable levels. In the ideal situation new

laboratories need to be built along with the rehabilitation of the old ones.

FY 2008 funds are requested to strengthen the quality and scope of the laboratory equipment and services

for both undergraduate and graduate courses in the School of Medicine for improved long-term antiretroviral

treatment outcomes. The School of Medicine has often emphasized the need for requisite tools necessary

for the training of health professionals. One such critical area is the provision of quality laboratory

equipment. This does not just make training realistic but has capacity to save lives in the long term. Such

health professionals trained under such a favorable environment are likely to progress to be strong public

health professionals who will be equipped to respond to the prevention challenges caused by many public

health challenges, particularly those brought about HIV/AIDS/TB/STI epidemics.

Another activity to be supported in FY 2008 is the development, implementation, and evaluation of a

Certificate Program to prepare nurses in Zambia to provide comprehensive care, treatment and support,

including initiation of antiretroviral therapy (ART) for patients with HIV/AIDS. This activity is built on the

realization that an emerging strategy for addressing the health workforce shortage and rapidly increasing

access to HIV and other health services involves task-shifting or the redistribution of tasks among health

workforce teams. In this regard there is need to develop mechanisms for clinical mentoring and supervision

of workers who assume expanded roles, and for developing financial and/or non-financial incentives in

order to retain and enhance the performance of health workers with new or increased responsibilities. One

of the guidelines in the WHO report (2008) specifically addresses the recommendation that nurses and

midwives can safely and effectively undertake a range of HIV clinical services. The main focus of this

activity is to train nurses and expand their roles so that they are able to meet the challenges of HIV/AIDS

care and support programs, including ART therapy.

Given this background, this program area will focus to expand the tasks nurses are engaged in so that their

role is extended to meet the challenges of scaling up the ART services. This training will take place in three

phases.

The FY 2008 phase 1 goal is to implement the certificate course curriculum as a face-to-face (FTF) training

program with a pilot group of 20 nurses from four provinces in Zambia.

The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative

updates have been made to highlight progress and achievements.

The Master of Public Health (MPH) degree in Zambia is offered only by the University of Zambia (UNZA)

School of Medicine (SOM). The MPH program graduates an average of 30 students per year who become

leaders in public health delivery including policy making in Zambia and contribute to improving health

service delivery for HIV/AIDS and related services. The MPH program in the SOM is a major contributor to

the human resource development in public health in-line with human resource development and health

priorities of the Government of the Republic of Zambia. The Community Medicine Department in the SOM

has basic infrastructures and curriculum that need further strengthening with additional resources that will

be provided under this program. The funding in this program will strengthen the capacity of a local institution

in developing its curriculum and necessary human resources that will be involved in HIV/AIDS work thereby

ensuring long term sustainability in human resource development for the countrywide work in

TB/HIV/AIDS/STI.

To ensure the sustainability of human capacity building for public health evaluation methods and public

health delivery in TB/HIV/AIDS/STI in Zambia, FY 2008 funds will enable the UNZA MPH program to

develop concentrations in epidemiology and biostatistics by supporting student scholarships and faculty in

curriculum development, teaching, and resources to build these programs. Developing these

concentrations will enable the MPH to support and train additional HIV/AIDS health research professionals

with expertise in public health evaluation methodology, including study design, data management, statistical

analysis, scientific writing, preparation of manuscripts for publication in the scientific literature, methods and

resources for accessing international electronic health information and literature, and communication of

health information and research results to health professionals, policy makers, and the general public.

The FY 2008 funds will also provide support to the SOM in its training of post-graduates in clinical research

through the MMed program. The MMed degree is the primary training program to teach clinicians research

methodology through projects conducted in clinical departments. Support to this program will provide

MMed curriculum development and comprehensive review, faculty development in research methodology

and in teaching research methodology - particularly in HIV/AIDS operational research, seed money to

conduct research projects required of all MMed students, and to support external trainers to provide

teaching in research methodology who are not currently on faculty.

Support to sustainable institutional mechanisms is critical to effectively support Zambian educational

institutions and build partnerships with organizations and individuals in need of training and support to

develop critical human resources for public health care delivery. The curriculum under these activities will

also emphasize management, care, and prevention of pediatric AIDS. In addition, prevention and early

access to pediatric care will be strengthened through the prevention of mother to child transmission

program.