This activity was formally conducted by Churches Health Association of Zambia (CHAZ), however

AIDSRelief has assumed the role of continuing to implement this continuation (9734.08) at the request of

CHAZ who are now unable to expend both Global Fund and PEPFAR resources. In FY 2006, CHAZ

implemented this activity as a sub-partner of AIDSRelief.

AIDSRelief plans to build on year-five successes in the provision of antiretroviral therapy (ART) by ensuring

that prevention of mother to child transmission of HIV (PMTCT) is a part of the comprehensive, integrated,

sustainable, and family-centered care that is necessary to provide for people living with HIV. AIDSRelief

has consistently provided evidence-based education and training to health workers at its local partner

treatment facilities (LPTF) on effective PMTCT interventions. In order to increase the scope of influence

and the number of services provided, AIDSRelief is requesting funds to implement quality, comprehensive,

family-centered HIV care to pregnant women and their families. Their PMTCT strategy includes three target

areas to be addressed at all 19 sites: 1) establishing community-wide identification of HIV-infected

pregnant women; 2) engaging HIV-infected pregnant women into comprehensive HIV care and treatment;

and 3) providing effective antiretroviral treatment and prophylaxis for pregnant HIV-infected women.

AIDSRelief will support 19 LPTF to meet the needs of the communities they serve by building and

strengthening their capacities for PMTCT through an integrated family-centered HIV care and treatment

approach. By strengthening institutional capacity, and facilitating active community involvement, AIDSRelief

will continue to move toward its target in the most effective and sustainable manner.

The first strategy of this program is to establish community-wide identification of HIV-infected pregnant

women. The first step to accomplish this will be to assist the 19 LPTFs and their satellites to regularly

sensitize community members (including male and female leaders, spiritual leaders, teachers and local

government leaders) to the benefits of HIV testing and treatment in pregnancy. AIDSRelief will link with

partner programs linking men to PMTCT care to accomplish this goal. The second intervention will be to

ensure that all nurses, midwives and active Traditional Birth Attendants (TBAs) are competent at providing

correct, evidence-based HIV counseling with an opt-out approach. This will be done at static antenatal

clinics (ANC) and satellite/outreach ANC clinics; and, it will be offered at booking and throughout all stages

of pregnancy, including during labor for women who did not receive a test during antenatal care. Thirdly, all

nurses, midwives, and active TBAs will be able to perform on-site/same day rapid HIV testing with reflex

CD4 testing. Fourthly, an effective outreach program will be established to reach families in the most rural

areas with the same services, but in a mobile setting. This will require that the LPTFs have enough trained

personnel to do regular mobile ANC and ART clinics. Funds under this component will be used to procure

and distribute back-up supplies needed to meet the increased needs and for training antenatal clinic staff,

TBAs and maternity ward staff in opt-out. Counseling and testing (CT) funds will also be used to mobilize

the community to engage in PMTCT efforts, including male participation in ANC, community-driven stigma-

reduction activities and community education about HIV.

The second strategy of this PMTCT program is to engage HIV-infected pregnant women and their families

into comprehensive HIV care and treatment. To accomplish this, it will be necessary to establish at each 19

LPTFs a formal mechanism for newly-identified HIV-positive women to be immediately enrolled into a

comprehensive HIV care and treatment program. This can be accomplished by bringing ART providers to

the ANC so that the women can be evaluated in ANC, or a pregnant woman can be referred to the ART

clinic with a referral slip. Pregnant women will be given priority in an ART clinic, in accordance with the

National Guidelines, so that she can make appropriate decisions in good time. The next step will be to

establish formal treatment preparation process for pregnant women that includes evidence-based infant

feeding education, maternal-to child transmission prevention education and ART options, including

antiretroviral drugs (ARVs) in pregnancy and adherence. All ART providers and counselors will be trained

or updated on evidence-based infant feeding guidelines to ensure HIV-exposed and HIV-positive babies get

the best nutrition they can with a lowest risk of HIV transmission. Local Partner Treatment Facilities will be

supported to ensure these women deliver in the hospital with a trained provider. Funds will be used for

training and updating staff members in the benefits of comprehensive HIV care for all pregnant women; for

the technical assistance needed to educate counselors on appropriate treatment preparation for pregnant

women, and for infant feeding training for health care workers (HCWs), TBAs and counselors.

The third strategy will be to provide effective ART or prophylaxis for pregnant women, nursing women and

their families. This will be accomplished by training and updating all relevant health care workers (medical

officers, clinical officers, and nurses) in the management of pregnant HIV-infected women, including the

updated national ART and PMTCT guidelines, and evidence-based research from resource-limited settings.

Special technical assistance will be provided for the ART providers so that they know how to manage the

unique challenges of HIV in pregnancy. Additionally, all relevant HCWs will be trained and updated in

opportunistic infection (OI) prophylaxis. Each LPTF will be supported to ensure that their laboratory can

provide quality ART safety and efficacy monitoring for pregnant women with a reasonable turn around time;

and that the pharmacy is also equipped to provide the ARVs and OI prophylaxis to pregnant women and

their families. One of the real challenges with this strategy will be reaching the women who live in very rural

areas. Each LPTF will be supported to provide mobile ART or satellite clinics for families who cannot reach

the central ART clinic. Funds in this area will be used for the training/updates needed for the ART providers

and the HCWs working in the ART clinic. Funds will also be used to create mobile or satellite clinics for the

rural populations, and will include the transportation of ARVs, laboratory and pharmacy personnel,

counselors and clinicians.

All babies born to HIV-infected mothers will be automatically enrolled into the ART program and

comprehensive, quality exposed-baby care will be provided, including infant testing at six weeks of age,

cotrimoxazole prophylaxis and growth and development monitoring. This is further explained in the

pediatric narrative.

By this intervention, AIDSRelief will address the legislative area of gender inequality by providing yet

another avenue for HIV positive women to access ART, hence improving their chances for survival and their

continued ability to care for their families. Through routine opt-out counseling and testing and through

community mobilization activities, stigma and discrimination will continue to be targeted as a key area to be

Activity Narrative: addressed by this program.

AIDSRelief will target 18,000 pregnant women for counseling and testing; 90% of whom will be enrolled into

a comprehensive HIV care and treatment program; 3,500 women for a complete course of appropriate ARV

treatment or prophylaxis; 90% of positive women to deliver in a health facility and 145 health workers will be

trained or retrained in the provision of PMTCT services.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Gender

* Addressing male norms and behaviors

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $100,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

April 2009 Reprogramming: Prime Partner changed to Catholic Relief Services

The LinkNet activity will continue to bring the fight against HIV-AIDS to some of the harder-to-reach districts

in Zambia. This activity improves the quality of HIV Care, Prevention, and Treatment by establishing locally

sustained deployment of the essential health communications, Electronic Health Record (EHR) Systems,

and other Health Management Information Systems needed for sustaining quality care in poorly connected

remote locations.

This activity is linked to JHPIEGO (3710.08), Ministry of Health (MOH) (3713.08), Centers for Disease

Control and Prevention (CDC) Technical Assistance (TA) (3714.08).

These improvements are achieved through a partnering with private partner PrivaServe Foundation for the

deployment of reliable quality, locally run ICT (Information and Communications Technology) services in an

increasing number of remote hospitals and their communities in Zambia thereby leveraging the scaling-up,

support and sustainability of the Zambia Ministry of Health SmartCare Electronic Health Record (EHR)

system in clinics in the vicinity of these hospitals - improving the numbers of people receiving care and

preventive services, and the quality and sustainability of that care.

As a Public-Private Partnership (PPP) the LinkNet continuation activity will extend the proof of concept

demonstrated by PrivaServe Foundation at Macha in 2006-2008, and Mukinge 2008, in a larger number of

other similarly remote hospital and clinic locations in Zambia by continuing to replicate the Macha and

Mukinge successes. These successes are measured in part by the high degree of local buy-in, community

skills acquisition levels, stewardship and other elements of long term sustainability, in addition to the direct

and indirect clinical services benefits.

This activity continuation positively affects the quality of treatment to thousands of HIV/AIDS patients, and

extends the means to disseminate information directly to (and from) providers, improving management of

HIV Care, and Prevention - and as a side effect, improving local retention of otherwise more isolated

clinicians. There exists a strong working relationship between LinkNet and CHAZ upon which this

collaboration builds.

The individual level EHR information resulting from routine provision of care, will, through SmartCare in

aggregate form, automatically feed the national Health Management Information System (HMIS) from these

same sites, improving the quality, timeliness and richness of this existing Zambian information stream, and

removing the direct burden of manually collecting this service management information that is key for

budgeting, logistics, and supply.

The LinkNet activity leverages both the SmartCare urban success and the success of the LinkNet proof of

concept for community sustainable ICT rural hospital projects in Macha and Mukinge and in other similar

project sites in rural Zambia, to help in the national deployment and linking of this new national health

information system.

Targets set for this activity cover a period ending September 30, 2010.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16972

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16972 16972.08 HHS/Centers for Churches Health 7167 2976.08 CHAZ - $500,000

Disease Control & Association of U62/CCU25157

Prevention Zambia

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $100,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

This activity will strengthen the capacity to train more nurses in rural Zambia. In FY 2009 facilities at the

Nurse Training School (NTS) at Macha Mission Hospital will be expanded with full-scale introduction of

Information and Communication Technologies (ICT) in the NTS environment.

The NTS at Macha operates at a level of 60 students in a two year training program according to the

national standards. There are currently 30 graduates from this program per year that are then placed in

Zambian health facilities. The aim of this activity is to double the intake by producing 60 graduates per year

without increasing the workload on the teaching staff.

In FY 2009 this activity will implement the necessary infrastructure components to make this possible. One

component is building two new, fully ICT-equipped classrooms, linked with the internet. The second

component is to assure full presence of computers at all school facilities with each connected to the

Internet.

With information available any-time and everywhere, a new way of learning will be introduced. The

traditional focus on knowledge acquisition with students having many hours of interaction with limited

instructors will be augmented with a problem-solving way of learning. ICTs will facilitate continuous learning

and encourage students to work in teams with a focus on skills acquisition rather then knowledge

acquisition.

Over one hundred (100) computers, all fully connected to the internet will be deployed at the NTS. This

assures availability of information resources for every student in the school at all times. Thus the amount of

teacher contact hours per student will be lowered with increased self-study using resources on the Internet.

Complete deployment of ICTs will facilitate integration of the SmartCare system at the student level Allow

for the use of SmartCare structured clinical protocols, such as those defined for the provision of ART or

PMTCT, based on best practices developed with the Zambia program in urban parts of the country like

Lusaka where the PMTCT and ART programs have shown remarkable results of improved patient care.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.18: