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Zambia HIV/AIDS Prevention, Care and Treatment (ZPCT) Partnership Cooperative Agreement No

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Zambia HIV/AIDS Prevention, Care and Treatment (ZPCT) Partnership Cooperative Agreement No Zambia HIV/AIDS Prevention, Care and Treatment (ZPCT) Partnership Cooperative Agreement No. 690-A-00-04-00319-00 Quarterly Report for January 1– March 31, 2007 Submitted by Family Health International (FHI) April 30, 2007 1. EXECUTIVE SUMMARY The Zambia HIV/AIDS Prevention, Care and Treatment (ZPCT) Partnership works with the Ministry of Health (MOH), the Provincial Health Offices (PHOs), and District Health Management Teams (DHMTs) to strengthen and expand HIV/AIDS related services in five provinces: Central, Copperbelt, Luapula, Northern and North Western. The Partnership supports the Government of the Republic of Zambia (GRZ) goals of reducing prevalence rates and providing antiretroviral therapy (ART) by implementing technical, program and management strategies to initiate, improve and scale-up prevention of mother-to-child transmission (PMTCT), counseling and testing (CT) and clinical care services for people living with HIV/AIDS (PLHA), including ART. ZPCT is currently supporting implementation of HIV/AIDS services in 87 health facilities in 25 districts in the five target provinces. Services were initiated and/or strengthened in 43 facilities in nine districts in April 2005, and subsequently expanded to an additional 39 facilities in October 2005. Since then, ZPCT has expanded support to HIV/AIDS services in five new health facilities, including ART, during the current workplan period. During this quarter, ZPCT provided support to 87 facilities in 25 districts. Technical assistance, staff training and other preparatory activities have continued to strengthen services in the five new health facilities. Key activities and achievements for this reporting period include: CT services are ongoing in 86 health facilities. 23,658 individuals received CT services in ZPCT-supported facilities this quarter. PMTCT services were provided in 86 ZPCT-supported facilities. 16,850 women were provided with PMTCT services (including CT), and 1,464 were provided with a complete course of ARV prophylaxis. Ongoing assistance (training, technical assistance visits, and/or renovation) was provided to expand and improve clinical palliative care services in 87 health facilities. 44,817 individuals received palliative care in ZPCT-supported health facilities during this quarter. ART services were available in all 25 districts supported by ZPCT. A total of 5,150 new clients (including 352 children) were initiated on antiretroviral therapy through 52 ART centers (including 24 outreach sites) this quarter. By the end of this reporting period, 32,950 individuals were receiving antiretroviral therapy at ZPCT-supported sites; of these, 2,203 were children. Nine technical training courses were conducted: 32 HCWs were trained in two, one-week refresher CT courses and 11 HCWs were trained as counselor supervisors in a two-week workshop. 36 HCWs were trained in ART and Management of Opportunistic Infections (OI) in two, one-week refresher courses in Central and Northern Provinces. 74 HCWs from 20 health facilities were trained in Management of Pediatric of ART/OIs in four, three- day trainings in Luapula and Copperbelt Provinces. Implementation of quality assurance and quality improvement (QA/QI) tools in CT, PMTCT, ART, clinical palliative care, laboratory and pharmacy (developed by ZPCT with the MOH) are ongoing in all five provinces. The tools will be further refined in the next six months. ZPCT has completed the development of a database to analyze results from the administration of the tools. The software was pre-tested this quarter in Luapula Province and subsequently rolled-out to all provinces. ZPCT staff have developed a Facility Graduation Sustainability Plan to use QA/QI tools to determine when a facility has achieved and sustained a high level of technical quality in implementation of HIV/AIDS services and requires minimal support from ZPCT. On-going monitoring and supervision will continue to be provided by the PHO or DHMT. This is part of the ZPCT strategy to ensure lasting impact and sustainability of activities beyond the ZPCT program. ZPCT installed two BD FACSCount Machines at Mahatma Gandhi Health Center (Kabwe District, Central Province) and Solwezi General Hospital (Solwezi District, North Western Province). Thirteen chemistry analyzers (Humalyzer 2000) were received during the quarter, five of which were installed and commissioned in North Western and Copperbelt provinces. In addition, five autoclaves were received, to be installed in the next quarter. ZPCT continues to coordinate the distribution of CD4, hematology and chemistry reagents procured by earlier in the year. New consignments were procured, to supplement the FACSCalibur reagents used at Arthur Davidson Children’s Hospital in Ndola, another for the Ndola Central Hospital FACSCalibur once the equipment is in place, and the other consignment as an emergency stop gap procurement for FACSCount. Provincial staff are continuing to strengthen referral networks in nine Phase 1 districts, and have initiated referral network activities in Serenje District, Central Province. ZPCT has identified and worked with 11 community groups to develop community purchase orders (CPOs) to enable the groups to conduct mobilization activities in communities surrounding ZPCT-supported facilities. Community mobilization activities are underway in all five ZPCT-supported provinces. Amendments were executed for ten recipient agreements, primarily to support extra shifts and furniture for testing corners in children’s wards to facilitate counseling and testing for children in care. ZPCT staff members continue to provide assistance and leadership on technical and programmatic issues in all key areas at the central level. ZPCT actively participates on eight national technical working groups, as well as several ad-hoc implementation groups. ZPCT continued to participate in planning for the roll-out of the Continuity of Care Patient Tracking System (CCPTS), including development of a standard training package for the CCPTS to be used nationally. World TB Day (March 24, 2007): ZPCT staff participated in activities to commemorate World TB Day in the five target provinces, including the national event that took place in Kabwe, Central Province. An assessment team from the Office of the Global AIDS Coordinator (OGAC) visited seven ZPCT- supported ART sites in Copperbelt Province on March 14-16, 2007 to review the U.S. Government’s support to the MOH in implementing ART services. A team of USAID staff visited ZPCT on March 12, 2007 to conduct a data review in the areas of monitoring and evaluation, finance and administration and human resources. ZPCT submitted the following four abstracts for the President’s Emergency Plan for AIDS Relief Conference scheduled in June 2007 in Kigali, Rwanda: o Increasing Uptake in Pediatric HIV Care in Resource Limited Settings; Practical and Programmatic Options o Improving Adherence to ART in Resource Constrained Setting: The Role of Adherence Support Workers o Building a Strong Partnership with the MOH to Scale up ART in Zambia (This abstract was accepted for a poster session.) o Referral Network model in Kabwe District in Central Province of Zambia increases access to the continuum of services for PLHA Results for the quarter are summarized in the following table: ZPCT Quarterly Report (January 1 – March 31, 2007) 2 Services in 87 Facilities Receiving ZPCT Support January 1 – March 31, 2007 Achievements May 1, 2005 to March 31, 2007 Indicator Workplan Percent Cumulative LOP Quarterly Achievements Achievements (Apr 06 to Achievement Achievements (1 Jan 07 to 31 Mar 07) (Apr 06 to Mar Mar 07) (Apr 06 to (May 05 to Mar 07) TARGET FEMALE MALE TOTAL Mar 07 ) 07 ) CT Service Outlets 86 Persons Trained in CT 402 43 399 99% 779 Persons receive CT services 43,990 12,274 11,384 23,658 72,376 165% 105,759 PMTCT Service Outlets 86 Providers trained in PMTCT 200 0 141 71% 389 Pregnant women provided with PMTCT service, 30,033 16,850 16,850 57,909 193% 84,713 including CT Pregnant women provided with a complete course of 6,757 1,464 1,464 4,882 72% 6,745 ART prophylaxis Basic Health Care and Support Strengthen Facilities to provide clinical palliative care 87 services Service Outlets/programs providing general HIV- 87 related palliative care Persons provided OI management and/or 26,596 18,221 44,817 44,817 prophylaxis Persons provided with general HIV-related palliative 26,596 18,221 44,817 44,817 care Persons trained to provide 100 36 227 227% 610 general HIV- related care Treatment ART service outlets providing 52 treatment Health workers trained 100 36 227 227% 610 New clients for ART 13,686 3,016 2,134 5,150 18,950 138% 29,765 Persons receiving treatment 25,152 19,583 13,367 32,950 32,950 131% 32,950 Pediatric Treatment Health workers trained in 150 74 269 179% 269 pediatric care New pediatric clients for ART 395 171 181 352 1,293 327% 2,017 Pediatric patients receiving 1,019 1,124 1,079 2,203 2,203 216% 2,203 treatment TB and Care TB infected clients receiving 3,333 618 630 1,248 4,121 124% 4,121 CT services HIV-infected clients attending HIV care/treatment services 1,641 214 247 461 1,563 95% 1,563 that are receiving treatment for TB disease (new cases) ZPCT Quarterly Report (January 1 – March 31, 2007) 3 2. INTRODUCTION The Zambia Prevention, Care and Treatment (ZPCT) Partnership works with the Ministry of Health (MOH), the Provincial Health Offices (PHOs), and District Health Management Teams (DHMTs) to strengthen and expand HIV/AIDS related services in five provinces: Central, Copperbelt, Luapula, Northern and North Western. The Partnership supports the Government of the Republic of Zambia (GRZ) goals of reducing prevalence rates and providing antiretroviral treatment (ART), by implementing program and management strategies to initiate, improve and scale up prevention of mother-to-child transmission (PMTCT), counseling and testing (CT) and clinical care services for people living with HIV/AIDS (PLHA), including ART programs in all ZPCT-supported districts in these five provinces.
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