CHAI in Zambia

Now back to mini-tutorials on life and work with the Clinton Foundation. Think have gone over Zambia, and the Clinton Foundation (and the HIV/AIDS Initiative - CHAI) in general, and now on to the next: CHAI in Zambia -

Although our Africa regional manager has been working in Zambia, and was based out of Lusaka, since 2006, the Zambia office didn't officially have an office, country director, or any staff until March 2007. And it started out as a wee consortium country in the world of CHAI countries, which meant that although there was some programmatic support to the Ministry of Health here, the office's main presence was for procurement of pediatric and adult second-line ARV's for the national system, using UNITAID funding (provided a French 1-euro taxes on airline tickets). I think the office started as 3 people around 2 desks in 1 room of an office borrowed from JSI. Chaos a bit.

Then, lots of chaos with the visit of former-Pres. Clinton in late July, and after some turnover with short-term volunteer staff in those first months, I arrived (to find the 2 office staff at that point almost suffering PTSD from the visit). And Zambia graduated from lowly consortium to souped-up "partner country" status (meaning more money and involved programmatic support provided).

At that point, Zambia was just kicking off programmatic support for the national pediatric HIV program. Zambia didn't even provide pediatric ARVs through the public health system until 2005, and there was a lot of ground work to be done. Scale-up (and meeting yearly targets of getting x # more children on ARVs ) was a huge focus and CHAI, with the Ministry of Health (MoH), was working aggressively to try and get the targeted 12,000 kids on treatment by the end of 2007.

Part of this was working on rolling out early-infant diagnosis (EID) of HIV, which requires a special test using DNA-PCR to conclusively diagnose the children of HIV-positive mothers as having HIV (separate from the maternal HIV antibodies which can give a false positive if an infant is given the normal rapid test in its first 18 months). It was the first time DNA-PCR, the "gold standard" of EID, was being introduced in Zambia, and bad news - only 3 labs in the country are equipped with the technology to run these tests. Good news: there's a dried blood spot (DBS) sample collection technique that is both easy to do and easy to transport (just a piece of paper). So there was a bit of work (understatement of the year) to do to make sure samples could be transported, results returned, and babies diagnosed.

Luckily, Marie arrived 2 weeks after me to officially create our peds department as the pediatric HIV coordinator for a team of, well, 2. And creating a database to track sites trained in collection of the blood samples required to run DNA-PCR tests, creating a transport network, and trying to count the number of new kiddos on ART kept us busy for the end of the year. Jill, our illustrious British procurement coordinator, meanwhile continued to place orders for all of the pediatric and adult 2L ARVs and we were chugging along in an office of now 5 (also Megumi, southern Africa regional malaria analyst and all-around good person) in 2 rooms of a new borrowed office.

CHAI Zambia's office has officially since then grown into an office of 11, now with some Zambian staff (finally) and our own building. We now work in clinical lab support (relating to HIV); expanded procurement of ARV's and other essential drugs associated with opportunistic infections; pediatric HIV support including clinical mentorship, provider-initiated testing and counseling, and helping maintain the now-national (hurrah) DNA-PCR transport network; malaria partnerships researching the feasibility of a private sector subsidy for ACT's in Zambia; and an entire HR department (4 people!) working with the MoH on the lack of health care workers in Zambia.

My work has changed (from peds to HR), but that's for another long-winded post.