Lusaka Provincial Medical Office (LPMO) has the mandate to perform core public health activities within the Lusaka Province as part of the MOH with the key functions being supervision of services, policy interpretation, data management and technical support. The province notifies about one third of the total tuberculosis patients in the country (18,626 out of 48,000 in 2010). 70% of these patients are HIV infected. LPMO will expand the provision of ART to HIV infected clients and ensure that TB screening is provided at all service delivery areas. The Provincial Health Office will coordinate all treatment and care activities with the other USG funded partners in the province such as CIDRZ and Intrahealth. LPMO will strengthen the provision of care to HIV infected clients enrolled in HIV care programs. Cotrimoxazole prophylaxis will be provided for both adults and children. The province will continue with the provision of a complete package of PMTCT services in all districts focusing on strengthening quality of care, addressing missed opportunities and gaps in service delivery and in order to contribute to the MOHs goal of elimination of MTCT. This will be achieved through ensuring the availability of the most efficacious regimens and provision of full HAART to all eligible women.These activities will be specifically designed to: Increase health worker retention in rural facilities for delivery of quality services; Increase utilization of maternity services; expand integration models for ANC and ART for increased coverage; Support development of integration models for PMTCT, pediatric HIV care, and routine MNCH services such as EPI, growth monitoring, nutritional support and post natal services.

Lusaka Province Medical Office will support the anti-retroviral treatment program by recruiting and training 15 health workers in ART/OI management, 50 health workers in STI Syndromic Management. 100 peer educators will be trained in adherence and psychosocial counseling in the 4 districts in order to provide adherence support to clients enrolled on ART and to provide prevention counseling with positives. The adherence supporters will support and make follow ups to all patients on treatment.

The Province will provide ongoing mentorship and support for peer educators and treatment supporters. Health workers will be trained in the recognition and treatment of opportunistic infections in PLWHA enrolled in HIV treatment and care. The province will ensure the provision of a complete package of care to these clients including linkages to services providing nutrition advice and support, malaria prevention and safe water supplies.

LPMO will ensure that HIV/AIDS /TB patients who co infected and eligible for co- trimoxazole prophylaxis are captured and commenced on treatment.

LPMO will improve the quality of laboratory services to support care and treatment through the provision of equipment such as CD 4 Machines and automated hematology and chemistry analyzers where necessary and ensure training of staff and maintenance of the equipment.

In order to strengthen mechanisms for collaboration between TB and HIV programs, LPHO will continue supporting provincial and district coordinating body activities. To reduce the burden of TB in HIV infected individuals, we will conduct trainings in intensified TB case finding in Anti-retroviral Therapy (ART) sites, Voluntary Counseling and Testing (VCT), Sexually Transmitted Infections (STI) and antenatal clinics. LPHO will conform to the new guidelines of providing ART to all TB patients regardless of their CD4.Trainings in ART management in TB will thus be reinforced. We will also train health workers in TB infection control and ensure TB infection control measures at facility levels are implemented. TB in children is also a source of worry and thus Health workers will be given special training in management of Childhood TB. LPHO will continue to coordinate the activities of partners and oversee the training of new health workers as well as refresher trainings and/or technical updates for selected health workers in TB/HIV clinical management. To reduce the burden of HIV in TB patients we will continue to conduct provider initiated counseling in TB clinics and OPD for both suspects and confirmed TB patients. These trainings will also include staff in congruent settings such as prisons. We will support districts in strengthening linkages and referral systems from TB to HIV

The (LPMO) will provide quality care and support to children living with and exposed to HIV/AIDS. Services will adhere to national standards, including national minimum standards for maternal and pediatric care, and for home based care, as well as PEPFAR Pediatric care and support. As allowed by the GRZ, community caregivers will promote or perform collection of dried blood spots (DBS) for HIV-exposed infants to increase Early Infant Diagnosis (EID). All children will receive the OGAC/ GRZ recommended child preventive care package; including co trimoxazole prophylaxis for HIV-exposed children. LPMO will also link with and assist in food and nutrition assessment, counseling and support, following national guidelines.

Where available linkages will be established with programs providing nutrition support to clinically malnourished clients. LPMO will adhere to national Nutrition and HIV guidance, as well as adopting the draft national Food by Prescription strategy to diagnose and treat malnutrition among pediatric PLWHA. When addressing the nutrition needs of infants and young children, the LPMO will follow national Infant and Young Child Feeding (IYCF) guidelines. A goal of infant/child feeding will be to ensure long-term HIV free survival of children.

LPMO will promote retention of HIV exposed babies and their mothers in care and treatment services for early infant diagnosis (EID).

In order to improve the quality of care LPMO will conduct trainings in psychosocial counseling, pediatric, HIV management and child counseling. LPMO will support the accreditation of 10 ART sites.

Other interventions may include malaria and TB screening, case-finding, and control measures. Other efforts will be directed towards increasing ownership and sustainability of care and support. All community-based care and support activities will link to and integrate with available clinic-based services, including HCT, PMTCT, OVC and ART.

Laboratory- Support implementation of district laboratory sample courier:

In order to expand access to laboratory testing for determination of ART eligibility (CD4 screening) and capacity to monitor patients on ART with lab screening, the provincial office will direct part of these PMTCT acceleration funds to addressing intra-district transport issues; these issues dramatically affect access to timely and comprehensive care. Such efforts will build on the planned scale-up of a national laboratories transport system. The province will implement this activity in the 3 most needy districts for moving laboratory specimens including DBS to the Hub laboratory and then results taken back to the requesting health facilities, build on the planned scale-up of a national laboratories transport system by the Ministry of Health headquarters. Where appropriate and based on Ministry of Health authorization, the province will strengthen access to lab services through procurement and deployment of point of care equipment rather than supporting transportation of laboratory samples.

Using part of the COP12 PMTCT plus up funds, the Lusaka Province Medical Office (LPMO) will continue to support existing Ministry of Health data (HMIS-DHIS) and patient care systems (SmartCare). Working with other cooperating partners, LPMO will strengthen the use and availability of SmartCare by performing routine district and facility based performance assessments, and data audits. This will include ensuring that data produced by SmartCare is used at all relevant levels, and that related data feeds into the HMIS-DHIS systems.

Because of its unique locations and circumstance with regards to partner based information system that need harmonization, LPMO will engage with CPs in ensuring that partner systems, such as ZEPRS, are migrated into SmartCare, to ensure compatibility and standardization of systems.

In order to maintain standards, LPMO will ensure that each district has at least one model SmartCare facility compatible with the HMIS-DHIS, which will serve as an example of a sound data and patient system.

In order to ensure that systems are running as expected, LPMO will support ICT infrastructure in its districts.

Human Resource Renovation of staff houses

To further contribute towards improved quality of clinical services and so increase coverage of comprehensive PMTCT services towards MTCT elimination through increasing presence of trained health workers in facilities where it has been difficult to attract or retain health workers, the LPMO will $50,000 from the COP12 plus-up funds to target the top 3 most needy districts, where it is still a challenge to attract staff to the districts especially in the hard to reach areas where housing for staff has been in a poor state. Renovation works will include replacement of worn out roofing sheets, broken window panes and shutters with locks, filling in of wall and floor cracks and painting of the houses and installing solar panels for power.

The LPMO will utilize the additional $312,104 from the Partnership Framework Implementation Plan (PFIP) allocated under COP12 to strengthen intra-district logistics supply systems covering drugs and laboratory commodities by procuring 6 utility vehicles. The vehicles will be dedicated to ensuring that commodities delivered to the district level are delivered to the health facilities in a timely manner and that whenever necessary, commodities are re-distributed between districts/facilities for assured commodity availability at each service delivery site. Being a part of the PFIP, the availability of driver as well and routine maintenance for these vehicles will be contributed by the MOH through the districts that will receive these vehicles.

LPHO will provide leadership in expanding male circumcision (MC) services to Chirundu and Sibuyuni districts in addition to Chongwe, Luangwa and Kafue Districts. LPHO will advocate for community involvement by engaging community leaders such as traditional rulers and other opinion leaders to mobilize communities for MC services. LPHO will facilitate human resource development through onsite and didactic training of staff. LPHO will support furnishing of the buildings and procurement of equipment and supplies. LPHO will link MC activities to HIV counseling and testing services in all facilities in order to contribute to the risk reduction in contracting HIV infection. In order to ensure sustainability of the program MC services will be integrated in regular health services provided by the district health teams. LPHO will support district in M&E and quality assurance through technical supportive visit, quarterly meetings and reports.

Lusaka Provincial Health Office (LPHO) will train health workers in psychosocial counseling, community volunteers in lay counseling, DCT, PITC and Rapid HIV testing. We will strengthen couple counseling in the districts through community sensitization and provide orientation to health workers on the need to provide counseling to couples. LPHO will continue sending sensitization messages through various forms of media such as drama and information, education, and communication (IEC) materials to the target population. For continuous improvement of the counseling environment.LPHO will provide technical supportive supervision on quarterly basis with a view to mentoring district supervisors and building supervisory capacity to ensure quality of counseling and testing services. We will monitor district activities in couple counseling through monthly and quarterly reports and quarterly performance review meetings.

Lusaka Provincial Health Office (LPHO) will support and build capacity for improved collaboration with stakeholders in TB/HIV control LPHO will expand community education and awareness regarding STIs and the risk they pose for HIV infection. In order to promote sustainability and lasting behavior change, we will support HIV prevention services as part of regular health services provided by the district health teams. LPHO will build capacity in all the eight districts of Lusaka, Chongwe, Kafue, Chilanga, Chirundu, Lufunsa and Luangwa. LPHO will support health education talks which will include STI prevention and treatment seeking behavior. Behavioral change communications that promote uptake of biomedical interventions such as MC, PMTCT, HTC will target young people (males and females) adult men and women in order to reduce the transmission of HIV. We will train Youth Peer Educators to deliver health talks in health facilities and in communities. LPHO will continue to engage and educate community leaders such as traditional rulers and other opinion leaders to conduct community mobilization for HIV education. LPHO will support all the districts to intensify interventions for people living with HIV (PwP) including promoting HIV testing and counseling of sex partners and other family members; support for disclosure of HIV test results to sex partners and family members; consistent condom use; ART adherence; and promotion of other risk reduction measures. LPHO will support districts to conduct HIV prevention activities through focus group discussions and drama performance. Through capacity building workshops, staff training and mentoring will take place and onsite supervision will be conducted regularly in order to ensure that appropriate preventive activities are being implemented. In order to promote effective and efficient use of resources, LPHO will ensure integration of preventive programs in the districts and coordinate partner programs in the province.

Using the base funds, the LPMO will continue scaling-up the number of PMTCT sites in the province to improve access to ART/PMTCT Integrated services; ANC HIV counseling and testing rates will be sustained through the training of health workers in PMTCT in line with MOH guidelines. Training in Quality Improvement and Assurance (QI/QA) for full institutionalization of QI/QA systems will be provided in all implementing sites.

Couple CT and male involvement will be encouraged in ANC through implementation of innovative strategies to increase male involvement that is tailored towards rural, peri-urban and urban settings.

In order to strengthen the community level interventions, LPMO will train community health workers, traditional birth attendants (TBA), and peer educators in community tracking of mother-baby pairs, community mobilization and community support to affected/infected families and will receive support to carry out these activities

MCH health personnel will be trained in TB screening in order to ensure that mothers who attend ANC are provided with TB screening.

LPMO will provide supervision and mentoring to all implementing sites on regular basis

and continue to implement innovative strategies for improved dried blood spots (DBS) turnaround time. Promoting of re-testing of HIV negative clients and particularly those in discordant relationships during antenatal and throughout the breast feeding period will be encouraged.

LPMO will implement strategies to enhance linkages of post-partum women and their partners and other children to care and treatment services. Innovative and contextually relevant strategies will be developed to ensure effective integration of HIV CT programs with family planning services and integration of PMTCT activities with youth friendly sexual and reproductive health services at all levels. LPMO will identify HIV negative couples and actively link the male partners to male circumcision services.

LPMO will implement programs that empower HIV negative women to take safer sexual choices/decisions for them to prevent HIV infection such as the promotion of female condom programing including community sensitization and education on how to use them, ensure commodity security in order to scale-up utilization, as well as the usual male condom promotion.

LPMO will coordinate with SCMS/JSI to support enhanced PMTCT commodities stock availability in all their supported service delivery sites/district in order to implement an efficacious program and eliminate use of single dose NVP.

LPMO will strengthen syphilis screening and treatment amongst pregnant women with their partners.

LPMO will strengthen linkages to appropriate FP services for HIV positive people and their partners.

Using the COP12 PMTCT PLUS UP funds ($170,000), SPHO will implement one-off activities intended to strengthen the base of the PMTCT program in the province. These activities will be designed to: Increase health worker retention in rural facilities; Increase utilization of maternity; continue to expand integration models for ANC and ART; Support development of integration models for PMTCT, pediatric HIV care, and routine MNCH services such as EPI, growth monitoring, nutritional support and post natal services; Continue to expand sustainable intra-district laboratory sample courier systems.

LPMO will provide leadership in the implementation of comprehensive HIV treatment services to district medical offices (DMO) and will assume greater responsibility for patient previously supported through CIDRZ in the province. LPMO will continue to support the strengthening of the mentorship program aimed at improving quality of care through support to clinical care teams.

Continuing medical education to staff trained in ART will be provided at existing ART sites. LPMO will ensure that ART is readily available for HIV positive pregnant women and train health workers in ART, and continue to support DMO in the provision of mobile ART services in selected sites. LPMO will integrate ART in TB and PMTC services for timely commencement of ART in TB and pregnant women. The focus will be quality and cost effective care for ART patients, while increasing access to ART services.

In an effort to strengthen the early detection and management of cervical cancer (CC) in HIV patients, health workers will be trained in CC screening and sensitization of the community in all the ART sites. In addition, the LPMO will procure CC screening supplies to integrate screening of CC in ART sites.

LPMO will train peer educators in adherence counseling who will help with patient tracking. Resources will be provided for assessment of ART sites, provision of technical and logistical support to the ART sites in order for them to attain Medical Council of Zambia accreditation standards. LPMO will support infrastructure improvements at new sites in order to increase ART access with integration of prevention with positives in all ART sites.

The Lusaka Province Medical Office (LPMO) will train Health Workers (HW) from all potential entry points, (e.g., Maternal and Child Health (MCH) and Outpatient Department (OPD), to improve identification of children requiring definitive diagnosis. Thus, healthcare workers will be trained in Comprehensive Pediatric HIV Care (CPHC) and Integrated Management of childhood illnesses (IMCI) to increase the proportion of facilities having at least one healthcare worker trained in CPHC and IMCI. Another group of healthcare workers and community health workers (CHW) will be trained in Provider -Initiated Testing and Counseling (PITC).

The LPMO will train HW in DBS collection. To ensure quality scale-up of pediatric ART services, we will continue to strengthen clinical mentoring at district level and provide technical up-date meetings to ensure clinical practice is evidence based at all times.

Use of community volunteers for community sensitization shall continue and will be linked to the Family Support Unit (FSU) activity under counseling and testing. The production of behavioral change communication materials in local languages will also be supported. CHW roles will include family psychosocial support and community tracking for adherence purposes.

In order to improve the quality of care LPMO will conduct trainings in PITC and peer educators.LPHO will support the scale up of HIV exposed infant tracking systems.

In line with Medical Council of Zambia requirements for ART site accreditation, we will strengthen quality assurance, and provision of technical assistance for setting up systems in all hospitals in the province. The LPMO will also support the production of job aids such as algorithms and dosing charts. LPMO will support assessment, retention and adherence of pediatrics on the ART program including support for adolescent activities. We will leverage resources to incorporate nutrition support for children in underprivileged families.