• 2016–2021

Overview

The ACHIEVE program, implemented with support from CDC and PEPFAR, supported the Government of Zambia to advance toward HIV epidemic control over a five-year period (October 2016–September 2021). The program operated across four provinces i.e. Eastern, Southern, Western, and Lusaka, and progressively transitioned from direct service delivery to technical assistance, in line with national priorities for national program HIV ownership and sustainability.

All interventions were aligned with the Zambia National Health Strategic Plan (2017–2021), the National AIDS Strategic Framework, and Joint UNAIDS targets. ACHIEVE focused on identifying gaps, strengthening systems, improving service quality, and building government capacity to deliver and sustain comprehensive HIV services across the prevention to treatment continuum.

Core Program Strategy

ACHIEVE was guided by five interlinked strategies:

• Strengthening monitoring, evaluation, and routine data use through SmartCare, DHIS2, and cohort monitoring.
• Using data to target services to high-impact populations and locations.
• Expanding and institutionalizing the Community – Facility Linkage Model.
• Applying continuous quality improvement to improve facility performance.
• Transitioning services to GRZ through district-level capacity building.

By the end of the program, direct service delivery had been fully transitioned in all supported provinces, with CIDRZ continuing to provide targeted technical assistance where needed.

Key Achievements

1. HIV Testing, Prevention, and Linkage
   ACHIEVE substantially expanded access to HIV testing through facility- and community-based approaches, including provider-initiated testing, index testing, HIV self-testing, and targeted outreach for men, children, and key populations. Over the program period, more than 3.5 million HIV tests were conducted, with strong linkage systems ensuring that most individuals diagnosed with HIV were successfully linked to care. The program also strengthened access to combination prevention, including condom programming, PrEP scale-up support, VMMC linkage, and GBV services.
2. PMTCT and Early Infant Diagnosis
   The program supported family-centred PMTCT services, reaching over 488,000 pregnant women with antenatal services and achieving high HIV status ascertainment. Early Infant Diagnosis coverage improved steadily over time, exceeding targets in later years, supported by strengthened tracking systems, peer-pairing models, and improved cohort monitoring. Capacity building of health workers and mentor mothers contributed to improved retention of mother and infant pairs.
3. Adult HIV Treatment and Retention
   ACHIEVE supported expansion of test-and-treat to all supported facilities and health posts, contributing to improved ART initiation, retention, and viral suppression. By the end of the program period, most supported provinces had achieved UNAIDS 90-90-90 targets based on available estimates. The program strengthened differentiated service delivery models, appointment and defaulter-tracing systems, and peer-support interventions, while maintaining service continuity during the COVID-19 pandemic through multi-month dispensing and community delivery.
4. Paediatric and Adolescent HIV Services
   Targeted investments improved paediatric and adolescent case finding, linkage, and retention. The program strengthened the “Know Your Child’s HIV Status” strategy, adolescent-friendly services, peer educator models, and support groups. Paediatric ART capacity was expanded through training, mentorship, and establishment of centres of excellence, contributing to improved continuity of care for children and adolescents living with HIV.
5. TB/HIV Integration
   ACHIEVE strengthened TB/HIV collaborative services, achieving high TB screening coverage among people living with HIV and high ART uptake among TB/HIV co-infected patients. The program supported expansion of TB preventive therapy, improved diagnostics, laboratory systems, and TB/HIV data quality, contributing to improved detection and prevention outcomes.
6. VMMC, Cervical Cancer, and Key Populations
   The program supported large-scale delivery of voluntary medical male circumcision, exceeding annual targets and introducing innovations such as the Shang Ring device. Cervical cancer screening services were expanded nationwide, with over 183,000 women screened, including pilots of HPV testing among women living with HIV. Through the Key Population Investment Fund, ACHIEVE improved access to tailored HIV prevention and treatment services for key populations in high-burden settings.

Overall Impact

ACHIEVE demonstrated that HIV epidemic control is achievable when high-quality services, strong data systems, and government ownership are combined. Despite operational challenges, including COVID-19, the program delivered measurable improvements across prevention, treatment, and care, while leaving behind strengthened systems, skilled health workers, and sustainable models of service deliver.

A defining success of ACHIEVE was its contribution to sustainable health system strengthening. The program supported the nationwide SmartCare electronic health record system scale-up, improved data quality and routine data use, strengthened laboratory and pharmaceutical systems, and embedded CQI practices at facility and district levels. Progressive transition of services ensured that GRZ institutions could lead service delivery, with improved capacity to manage HIV programs independently.