Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 412
Country/Region: Zambia
Year: 2009
Main Partner: World Vision
Main Partner Program: NA
Organizational Type: FBO
Funding Agency: USAID
Total Funding: $2,990,011

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $413,215

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

RAPIDS cooperative agreement will end in December of 2009. The project will continue activities with all

partners during October 2009 and then begin the phase over process to the new mechanism. This phase

over process will begin soon after the new mechanism is awarded and the new cooperative agreement

comes into effect. Plans for phase over will include programmatic topics, staffing, finance, disposal of

assets, and continuity of care for all RAPIDS clients. There will be a concerted effort for a fluid transition to

ensure that both clients and caregivers are adequately supported. A lapse in programmatic coverage will

be avoided through a coordinated plan for phase over and thus a successful transition.

During FY 2008 modules on reproductive health and sexually transmitted infections (STIs) will be

incorporated into the HVAB curriculum. These modules will be utilized in FY 2008 and continuing into FY

2009.

Activity Narrative:

RAPIDS, which undertakes care and support activities in 52 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, orphans and vulnerable children (OVC), and people living with HIV/AIDS (PLWHA) within

the context of needs and priorities identified at a household level. RAPIDS will support the Zambia National

HIV/AIDS Prevention Strategy and may participate in 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 2009, RAPIDS expects to reach 3,786 youth with Abstinence and Being Faithful for Youth (ABY)

messaging. This number represents those youth graduating from a nine-month ABY life skills course.

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. 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. 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 Government of the Republic of Zambia (GRZ) to contribute to the National Youth Policy field

implementation and monitoring.

In FY 2008 and to the extent possible in Oct. 2009, RAPIDS will adapt and distribute a variety of AB

information, education, communication (IEC) materials in coordination with national abstinence and being

faithful (AB)-related campaigns and with the PEPFAR-funded health communication partnership (HCP)

Project. 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 monitoring and evaluation (M&E) tools to align with overall PEPFAR guidelines and

indicators, which are currently under review. As a matter of practice, RAPIDS M&E will also correspond

with the "Three Ones." RAPIDS will support consortium members in utilizing the ABY M&E systems

developed in FY 2008, capable of documenting interventions and demonstrating impact. RAPIDS will

encourage documentation of case studies/success stories at all levels.

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. 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.

In FY 2008 and to the extent possible in Oct. 2009, 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 FY 2008 and to the extent possible in Oct. 2009, RAPIDS will enhance the nutritional status of youth and

at-risk OVC by providing life skills and 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. The effort will not

focus only on one side of the problem, younger women as "victims." This will also include efforts to

discourage older male behavior ("perpetrators") from using their financial advantages to exploit younger

women as well. 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 Society

for Family Health (SFH) and according to GRZ and USG guidelines, RAPIDS will help to promote male

circumcision as a prevention method.

In the closing months of RAPIDS, staff and volunteers 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 will involve identification of key service providers, formalization of

collaborative relationships, and follow-ups. RAPIDS's partners and sub grantees will continue and conclude

efforts to identify and refer at-risk youth to relevant services such as voluntary counseling and testing for

HIV (VCT), sexually transmitted infections (STI) testing, and treatment. The community-based counseling

and testing (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

Activity Narrative: experience and job opportunities.

RAPIDS's 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 will link CBOs and FBOs to 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. These

opportunities for cascading training will have equipped the FBOs/CBOs with management and fundraising

skills.

In addition, RAPIDS provides 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 appropriate to each setting and local markets.

Over the last five years, the RAPIDS sub-grant program equipped CBOs/FBOs working in AB to respond to

HIV/AIDS in their communities more effectively through mentorship and training. All sub-grantees will be

identified to the new USAID mechanism, ideally with GPS coordinates, a brief description, and performance

review. The funding for GPS has not been identified but will be sought during FY 2008.

Because AB clients will not carry over from COP FY 2008, RAPIDS will only begin to provide AB services

for one month early in COP FY 2009, resulting in a massive decrease of over 90% from COP FY 2008.

RAPIDS will still count and report the youth it reaches as direct clients.

All FY 2009 targets will be reached by October 31st, 2009.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14439

Continued Associated Activity Information

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

System ID System ID

14439 3556.08 U.S. Agency for World Vision 6841 412.08 RAPIDS $2,408,152

International International

Development

8945 3556.07 U.S. Agency for World Vision 4995 412.07 RAPIDS $2,066,700

International International

Development

3556 3556.06 U.S. Agency for World Vision 2922 412.06 RAPIDS $1,590,000

International International

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

* Increasing women's legal rights

* Reducing violence and coercion

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $35,846

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.02:

Funding for Care: Adult Care and Support (HBHC): $925,379

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

RAPIDS cooperative agreement will end in December of 2009. The project will continue activities with all

partners during October 2009 and then begin the phase over process to a new follow on mechanism. This

phase over process will begin soon after the new mechanism is awarded and the new cooperative

agreement comes into effect. Plans for phase over will include programmatic topics, staffing, finance,

disposal of assets, and continuity of care for all RAPIDS clients. There will be a concerted effort for a fluid

transition to ensure that both clients and caregivers are adequately supported. A lapse in programmatic

coverage will be avoided through a coordinated plan for phase over and thus a successful transition.

Activity Narrative:

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

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

Ministries. Other emphases include: continued strengthening of pediatric care and closer linkages to

pediatric ART sites with emphasis on referral of HIV-exposed infants for early diagnosis using Dry Blood

Spot (DBS) samples and 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 while collaborating with USG Zambia on client-focused strategies for food

and nutrition support.

RAPIDS will also build on extensive malaria control activities which began during FY 2007 to reduce malaria

-related illness in PLWHA. In FY 2009, RAPIDS will refer clients to hospice and will support routine

cotrimoxazole prophylaxis for all HIV-infected clients possible. In FY 2008 and continuing in FY 2009,

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

management of simple and moderate pain will be included as part of the minimum standard of care for

PLWHA. Lastly, RAPIDS will emphasize sustainability in these last few months of operation of the grant by

linking caregivers with the new mechanism.

RAPIDS, which undertakes care and support activities in 52 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 2009, RAPIDS plans to provide home- and community-based palliative care and support to 51,855

PLWHA. This is possible as caregivers will continue to visit clients in their homes and other community

settings, even during the last month of programming. As more HBHC clients go on ART, and return to

active life, RAPIDS will provide care outside the home. This will include the formation and support of

Positive Living groups. Caregivers will also conduct outreach in designated sites for those who are

ambulatory.

Care and support "outreach" sessions offered to ambulatory clients in various convenient-locations. They

will save time and allows for more clients to receive services from each single caregiver. However, there

are some drawbacks, such as potential loss of privacy and confidentiality, and overload of the caregiver. As

earlier stated, the phase over to the new mechanism will be in process and will address such issues, taking

into consideration that each client should be aware of new projects providing modified support services.

Quality Assurance (QA), while evident in project design and monitoring, gains focus in FY 2008, and in FY

2009 will continue to be a priority. QA mechanisms include caregiver checklists, patient chart review, and

monthly care improvement meetings between caregivers and nurse supervisors.

Palliative care services 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. RAPIDS will continue to counsel PLWHA on behavior change

(reduction in alcohol intake to decrease risky sexual behavior), nutrition, and provide appropriate, factual

information on 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 FY 2008, RAPIDS will place a HBPC Policy Technical Advisor at the Ministry of Health, who will continue

into COP 09. This experienced key staff will promote innovations in palliative care in both policy and

practice. RAPIDS will also 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.

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

with the "Three Ones." RAPIDS also contributes 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 policy in home-based and palliative care support.

To the extent possible in the month of October, RAPIDS will, through private and corporate donations,

provide and resupply nurse and volunteer caregiver kits. In FY 2008 and FY 2009, WV will continue to

solicit in-kind donations of kits, while exploring more sustainable means to produce and resupply kits in

Zambia using local products, providers and facilities. Clients 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 public/private partnerships with USA corporations Gifts-In-Kind (GIK)

Activity Narrative: programs. Such items include raincoats, bags, shoes and bicycles. RAPIDS will continue "care for

caregivers" interventions to ensure that caregivers meet their basic needs while continuing to support

PLWHA.

At midterm, RAPIDS began to notice an increase in the percentage of male caregivers. Project staff will

continue to sensitize men to join caregiving activities both as clients and caregivers, striving to increase the

percent of men as clients in COP 08 and continuing this effort until close-out in COP 09. To reach men,

project staff will conduct sensitization meetings in the evenings, after normal working hours. Sensitization

meetings will also include information on income generating projects for caregivers and the value of certain

tools for work has on the ability of the household to generate income, e.g. bicycle.

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

Guidance. RAPIDS will support recommendations by FANTA and IYCN in determining nutritional needs,

and promoting better nutritional assessment and counseling, in close coordination with GRZ agencies such

as the National Food and Nutrition Commission (NFNC), NAC and the MOH Nutrition focal persons.

RAPIDS will collaborate with USG Zambia to develop and implement a food and nutrition strategy, including

a shift to a "Food by Prescription" approach.

In FY 2008 and continuing in FY 2009, RAPIDS will continue to reach out to Positive Living Groups with

clients referred directly from CT. Part of RAPIDS's strategy is to create a continuum of care wherein, once

a PLWHA enters a support group, he/she can access a range of basic services, both HIV directly related

(health/medical) and other socioeconomic, psychosocial and human rights/legal services. This strategy of

service provision, as well as support should motivate more men to join support groups.

Caregivers and HBHC providers will continue to combat stigma and discrimination by increasing

understanding of the disease and the challenges faced by PLWHA; encouraging participation of PLWHA in

the design and implementation of projects; and promoting 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 and ASAZA for example, to reduce violence

against women related to HIV diagnosis or discordant HIV results. Each project mentioned includes

counseling for men, for example, to reduce violence towards women, to teach new methods to resolve

conflict, and to improve communication and rapport.

RAPIDS designed and implemented a Training of Trainers (ToT) 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. ToTs will be encouraged to participate in the new

USAID mechanism.

All subgrantees will be identified to the new USAID mechanism, ideally with GPS coordinates, a brief

description, and performance review. The funding for GPS has not been identified but will be sought during

FY 2008. RAPIDS will recommend to the new USAID mechanism how to budget for workshops to inform

current subgrantees about options to apply for funding to continue their programming under the new

mechanism.

Because most care and support clients will carry over from COP 08, and will receive services early in COP

09, RAPIDS will count them and report them.

All FY 2009 targets will be reached by Oct 31, 2009.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14440

Continued Associated Activity Information

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

System ID System ID

14440 3558.08 U.S. Agency for World Vision 6841 412.08 RAPIDS $5,392,962

International International

Development

8946 3558.07 U.S. Agency for World Vision 4995 412.07 RAPIDS $4,034,064

International International

Development

3558 3558.06 U.S. Agency for World Vision 2922 412.06 RAPIDS $2,871,000

International International

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $63,292

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $35,000

Economic Strengthening

Education

Water

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $269,002

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

RAPIDS cooperative agreement will end in December of 2009. The project will continue activities with all

partners during October 2009 and then begin the phase over process to the new mechanism. This phase

over process will begin soon after the new mechanism is awarded and the new cooperative agreement

comes into effect. Plans for phase over will include programmatic topics, staffing, finance, disposal of

assets, and continuity of care for all RAPIDS clients. There will be a concerted effort for a fluid transition to

ensure that both clients and caregivers are adequately supported. A lapse in programmatic coverage will

be avoided through a coordinated plan for phase over and thus a successful transition.

Activity Narrative:

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

HKID, and HBHC. RAPIDS does not provide ART directly, rather, it supports adherence by clients of other

direct ART providers. 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 work closely with

therapeutic feeding for malnourished PLWHA and with infant and young child nutrition activities while

collaborating with USG Zambia on client-focused strategies for food and nutrition support. RAPIDS will

collaborate with USG Zambia to develop and implement a food and nutrition strategy, including shifting to a

"Food by Prescription" approach.

In Oct. 2009, RAPIDS will continue 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 existing HBHC programs in 52

districts.

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

order to do this, RAPIDS will work with HBHC coordinators and caregivers trained in ART literacy and

adherence, management of OIs and in referral networking. The program identifies client transport options,

linkages with HIV Counseling and Testing (CT) programs, and uses a wraparound approach to access food

supplementation.

Through adherence support efforts, RAPIDS will help the GRZ and USG Zambia to: support ART patients

and sites and support ART quality improvement and M&E. RAPIDS will employ established 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 continue to 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 will continue malaria control activities which began during FY 2007 to reduce malaria-related

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

RAPIDS, which undertakes care and support activities in 52 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 2009. RAPIDS will

reach 12,590 beneficiaries (out of the total 51,855 being directly reached with general home-based palliative

care (HBHC)) with ART access and adherence support services in the month of October 2009.

The current proportion of men to women in RAPIDS HBC programs is 60% women and 40% men, a

significant "gender gap," About half (50%) of the men and women are on ART. Every effort will also be

made to encourage men to be tested by availing CT in the home and at weekends. RAPIDS will continue

its efforts to increase the percent of men as ART adherence clients beginning in COP 08 and will continue

this effort until close-out in COP 09. Providing CT at more targeted venues and hours should assist in

reaching a higher proportion of men with testing, subsequent linkage to treatment and in turn adherence

support. These efforts will commence in FY 2008 and continue into FY 2009.

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

Livingstone, Ndola, and Kitwe. RAPIDS partners will build 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 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.

During October of 2009, 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

pediatric ART referral systems will ensure that HIV- positive pediatric patients from the HBHC program are

linked to ART services. RAPIDS will collaborate with AIDS-Relief and CIDRZ to identify and refer HIV-

positive children, where pediatric-ART services (PDTX) are available. These interventions will include

increase awareness, promote early CT, support parents managing ART for their children, promote issues

related to adherence, and enhance psychosocial support for pediatric ART clients.

These services will link to clinic-based services in specific areas where PDTX 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 pediatric treatment. 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.

Activity Narrative: RAPIDS will address gender concerns so that women and men are included in the ART program more

equitably, such as increasing the percent of men as clients. This will also be reflected in the 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 must 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. During FY 2008, as soon as the follow-on USG

mechanism is determined, RAPIDS staff will create an enabling environment for HTXS activities to continue.

From inception in FY 2004, RAPIDS designed and implemented 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.

Before and during the phase over period, RAPIDS will encourage local community-based organizations to

improve management skills and to access existing HIV/AIDS resource streams. To this end, WV has

developed a specialized Organizational Capacity Building (OCB) guide in order to ensure that the internal

capacities of community-led structures are sufficiently developed to sustain their important efforts in the long

term. The OCB guide is aimed at sub-grant recipients. RAPIDS will also invite the participation of GRZ

entities in OCB sessions. The OCB Guide focuses on strengthening the general organizational capacities

(as opposed to HIV/AIDS-specific technical skills) of CBOs. The OCB process is a three-stage, iterative

one, beginning with organizational self-assessment, followed by selected trainings based on the results of

the assessment, and supplemented with additional follow-up support.

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.

Because most adherence clients will carry over from COP 08, and will receive services early in COP 09,

RAPIDS will still count them, but will report them as direct clients. RAPIDS support is limited to adherence,

and does not include direct provision of ART.

All FY 2009 targets will be reached by October 31, 2009.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14443

Continued Associated Activity Information

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

System ID System ID

14443 3566.08 U.S. Agency for World Vision 6841 412.08 RAPIDS $1,567,700

International International

Development

8948 3566.07 U.S. Agency for World Vision 4995 412.07 RAPIDS $1,283,157

International International

Development

3566 3566.06 U.S. Agency for World Vision 2922 412.06 RAPIDS $1,061,000

International International

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $11,346

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.09:

Funding for Care: Orphans and Vulnerable Children (HKID): $1,235,186

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

RAPIDS cooperative agreement will end in December of 2009. The project will continue activities with all

partners during October 2009 and then begin the phase out process to the new mechanism. This phase out

process will begin soon after the new mechanism is awarded and the new cooperative agreement comes

into effect. Plans for phase out will include programmatic topics, staffing, finance, disposal of assets, and

continuity of care for all RAPIDS clients. There will be a concerted effort for a fluid transition to ensure that

both clients and caregivers are adequately supported. A lapse in programmatic coverage will be avoided

through a coordinated plan for phase out and thus a successful transition.

In FY 2008 and continuing in FY 2009, RAPIDS will deepen psychosocial support provision which includes

training caregivers to identify traumatized children that need therapy and refer them for professional

therapy. Thus, psychosocial support interventions will be measured with more detailed indicators. This

intervention will be piloted in the geographic areas where the A Safer Zambia (ASAZA) program is

implemented to allow for cross-referrals for victims of gender-based violence. While activities to provide

food security and sustainable livelihood options for households such as livestock restocking, community

gardens and provision of low level irrigation systems will be continued, other food strategies will be

developed in concert with USG. RAPIDS will collaborate with USG Zambia in the development and

implementation of a food and nutrition strategy as well as adopting elements of a common approach. A

shift to a client-focused shift to "Food by Prescription" is anticipated.

RAPIDS will conduct OVC activities throughout the month of October 2009, reaching 199,185 OVC with

supplemental direct support, rather than primary direct support. This is due to the fact that RAPIDS will not

be able to fund school fees a full term in advance.

Activity Narrative:

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. 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 which began 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

emphasize sustainability during FY 2008 and FY 2009.

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 52 of the 72 districts in Zambia.

A RAPID uses a household approach, creating a basis for supporting youth, OVC, and PLWHA within the

context of the household.

In the last month of client services, October 2009, RAPIDS plans to reach 199,185 OVC with supplemental

direct support. RAPIDS will continue to 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. Caregivers will facilitate referrals of potential HIV-positive infants and children

for HIV testing and 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 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 Sport, Youth and

Child Development, to help disseminate and implement the National Plan of Action for Children. The OVC

Policy Advisor will complete the training of staff and volunteers on new quality improvement techniques

acquired at an international conference on quality improvement in OVC programming led by USAID in

November 2008. This activity will begin in FY 2008 and conclude in FY 2009.

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

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

Kitwe. RAPIDS will support quality psychosocial pediatric support to CLWHA and their parents/guardians,

specializing in play therapy. Involving HIV-positive 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.

RAPIDS will continue to ensure gender mainstreaming and gender equity. 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 children especially the vulnerable girl child.

RAPIDS will also continue to promote positive male role models to influence behavior patterns in youth.

Activity Narrative: RAPIDS also include counseling for men to reduce violence and abuse towards girls, to teach new methods

to resolve conflict, and to improve gender relations.

RAPIDS will continue to work with USG and 27 OVC partners to operationalize the USG/OVC 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), NAC and the MOH Nutrition focal persons.

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

Zambia. 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."

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

and FBOs supporting OVC in FY 2008. The training targeted programmatic and management skills along

with stressing the importance of providing quality services to OVC. During the same trainings, RAPIDS

undertook skills building in fundraising so that sub grantees could access other existing HIV and AIDS

resource streams.

All sub grantees will be identified to the new USAID mechanism, ideally with GPS coordinates, a brief

description, and performance review. The funding for GPS has not been identified but will be sought during

FY 2008. RAPIDS will recommend to the new USAID mechanism to organize workshops to inform current

sub grantees about options to apply for funding to continue their programming under the new mechanism.

Because most OVC clients will carry over from COP 08, and will receive services early in COP 2009,

RAPIDS will count them and report them but as supplementary, not primary.

All FY 2009 targets will be reached by October 31st, 2009.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14441

Continued Associated Activity Information

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

System ID System ID

14441 3559.08 U.S. Agency for World Vision 6841 412.08 RAPIDS $7,198,487

International International

Development

8947 3559.07 U.S. Agency for World Vision 4995 412.07 RAPIDS $5,917,923

International International

Development

3559 3559.06 U.S. Agency for World Vision 2922 412.06 RAPIDS $4,565,000

International International

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Increasing women's legal rights

* Reducing violence and coercion

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $84,582

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.13:

Funding for Testing: HIV Testing and Counseling (HVCT): $147,229

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

RAPIDS cooperative agreement will end in December of 2009. The project will continue activities with all

partners during October 2009 and then begin the phase over process to the new mechanism. This phase

over process will begin soon after the new mechanism is awarded and the new cooperative agreement

comes into effect. Plans for phase over will include programmatic topics, staffing, finance, disposal of

assets, and continuity of care for all RAPIDS clients. There will be a concerted effort for a fluid transition to

ensure that both clients and caregivers are adequately supported. A lapse in programmatic coverage will

be avoided through a coordinated plan for phase over and thus a successful transition.

Activity Narrative:

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

HBHC. Activities and emphases include: testing at the household-level by finger-prick protocol 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. RAPIDS will create an enabling

environment for sustainability in the last month of programming, during FY 2008 and early FY 2009. 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) however, it is anticipated that there will be another USG mechanism to support CT beyond October

2009. RAPIDS will actively participate in the phase over to this mechanism.

RAPIDS, which undertakes care and support activities in 52 of the 72 districts in Zambia, is a consortium of

six international and local organizations: World Vision, AFRICARE, CARE International, 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, HIV-positive children, and OVC. RAPIDS will target providing VCT to 1,554 clients in FY 2009,

which is 1/12th of FY 2008 levels due to the time limitation.

RAPIDS will source rapid test kits through the GRZ test kit distribution mechanism. Test kits will be

distributed to caregivers to be supplied in caregiver kits to allow for testing in households. Static test

providers will be linked to the local district level supply chain of rapid test kits. The health care providers will

conduct CT for clients referred by lay counselors as well as through mobile outreach services in the

communities. Trained counselors under the Family Support Units will continue using rapid test kits so that

FSUs are able to continue their outreach services into the communities. 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 focuses on home/family-based testing. Through the household or family-

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

men, women, and home-and community based care (HBCC) clients and their family members. In addition

to direct counseling and testing, RAPIDS will continue with its CT, ART and PMTCT referrals.

Counselors will make immediate referrals for post-test clients to prevention, care, and ART services. Those

who are HIV-positive will be linked to ART services and PLWHA support groups or encouraged to create

new groups. Counselor caregivers will distribute CT promotional materials developed by other USG

programs such as HCP. 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 continue

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

program in FY 2008 and October of 2009 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. RAPIDS will give attention to the risk of violence for married women who seek CT without

advance knowledge or consent of their spouse. Other perceived barriers of women accessing CT are fear

of being thrown out of the house, the distance to CT sites is prohibitively far, and the high cost of transport

to CT sites.

For men, uptake of CT is often an issue. In FY 2008 and FY 2009, RAPIDS will address the low uptake of

men to CT by the following strategies: encouraging couples counseling, encouraging household testing,

focusing on the head of household as the decision-maker during counseling, and extending hours to

weekends to allow for CT outside normal working hours. To address accessibility, caregivers trained as

counselors will provide testing in the home and/or refer to mobile testing events. RAPIDS will continue its

efforts to increase the percent of men as CT clients, beginning in COP 08 and will continue this effort until

close-out in COP 09.

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

Activity Narrative: 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 2009 targets will be reached by October 31, 2009.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14442

Continued Associated Activity Information

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

System ID System ID

14442 3555.08 U.S. Agency for World Vision 6841 412.08 RAPIDS $858,028

International International

Development

8944 3555.07 U.S. Agency for World Vision 4995 412.07 RAPIDS $573,485

International International

Development

3555 3555.06 U.S. Agency for World Vision 2922 412.06 RAPIDS $350,000

International International

Development

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $4,935

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14:

Subpartners Total: $2,272,052
Africare: $653,770
Catholic Relief Services: $1,079,651
Expanded Church Response: $156,176
Salvation Army: NA
CARE International: $382,455
Cross Cutting Budget Categories and Known Amounts Total: $260,001
Human Resources for Health $35,846
Human Resources for Health $63,292
Food and Nutrition: Policy, Tools, and Service Delivery $25,000
Food and Nutrition: Commodities $35,000
Human Resources for Health $11,346
Human Resources for Health $84,582
Human Resources for Health $4,935