In collaboration with the Zambian Ministry of Health, CIDRZ began supporting ART programs in 4 of the 9 provinces in Zambia: Southern, Lusaka, Western, and Eastern in 2004. As of 31st July, 2007, CIDRZ supported sites have enrolled 108,578 adults and children and started 67,638 on. Within this program, CIDRZ has trained over 1,790 health care workers in Adult and Paediatric ART management, along with more than 1,200 peer educators and support group members in Adherence Counseling.
The ART Scale-Up program comprehensively addresses all aspects of health systems strengthening, including:
- Intensive community sensitization and follow-up
- Personnel training
- Clinical protocols and forms development
- Lab
- Pharmacy and health commodities
- Central logistics,
- Clinic level management
- Physical infrastructure
- Data/patient tracking
- Quality assurance.
Missed Visit Follow Up Program
The SmartCare patient tracking system allows real-time access to all program defaulters on a daily, weekly and monthly basis, allowing for weekly physical follow-up of defaulters. Follow up of patients missing pharmacy pick-ups results in a return of approximately 30% of defaulters.
Intensive VCT Program
In 2006, CIDRZ initiated the “Save Mtendere” program, focusing on intensive community outreach to increase uptake of VCT. This program consists of door-to-door community outreach, mobile VCT, targeted IEC materials, and radio programs to target individuals that are unable or unwilling to access VCT within the clinic setting. As of July 2007, more than 10,000 individuals have been counseled and tested through the program.
Implementation and Quality Assurance
Sites for ART Scale-Up are assessed and chosen in collaboration with Provincial and District Health Offices based on catchment area, capacity for scale-up and proximity of other ART programs. At site initiation, the CIDRZ Implementation and Quality Assurance team spends 2 weeks introducing forms, providing clinic supplies, and mentoring health care workers in management of ART patients. This is followed up by quarterly mentoring visits to ensure the highest quality patient care possible.
Physical Infrastructure
One of the major challenges of implementing ART Scale-Up in Zambia is the lack of adequate physical infrastructure to implement a viable ART clinic. Since 2004, CIDRZ has assisted with over $2 million in renovations and new clinic space, along with the building of an Adult Infectious Disease Center at the Universtiy Teaching Hospital, launched early 2007.
General Administrative Support
CIDRZ assists with recruitment as well as funding for part time shifts necessary for the ART clinics. For rural clinics, CIDRZ provides lab equipment and transport to facilitate specimen collection and delivery of results to the closest referral centres with lab facilities.