Table. Lessons learned from leveraging HIV programs to support COVID-19 vaccination, Zambia*.

Pillar	Lessons
Planning and coordination	• Leverage existing in-country systems/programs/resources for COVID-19 vaccination. • Engage national, provincial, and district health bodies from the outset. • Develop district-level microplans based on standard tools that are approved at provincial and national levels. • Use joint planning by Ministry of Health, funding organizations, and provincial representatives. • Establish centralized M&E tools for national tracking of progress. • Begin with a small pilot in a few sites and rapidly iterate to improve quality, using a continuous quality-improvement approach. • Scale-up successful practices rapidly to quickly enhance effect. • Develop targets that can be implemented and achieved by lower levels (i.e., district health offices, service delivery teams).
Service delivery	• Adequately capacitate HCWs in HIV, MCH, and other clinics to deliver COVID-19 vaccines. • Invest in community mobilization and service delivery to overcome limits of a static service delivery approach and reach the greatest number of eligible persons, which means offering vaccines at public places (e.g., markets, malls, churches), chiefdoms, workplaces, congregate settings, and others. • Use existing community health services for HIV as vaccination points. • Anticipate additional human resource needs, and ensure adequate financial resources to support them.
Demand generation	• Ensure adequate HCW training in HIV and other clinics to answer patients’ and eligible family members’ questions about COVID-19 vaccines. • Encourage HCWs themselves to get vaccinated against COVID-19 by creating a safe space for unvaccinated HCWs to have their questions answered. • Engage public and private media nationally to address myths and misconceptions about COVID-19 vaccines. • Develop promotional materials that emphasize the value of COVID-19 vaccination for persons living with HIV because of the elevated risk for severe illness among members of this group. • Engage civil society (community, traditional, religious, and business leaders) to champion COVID-19 vaccination. Listen to and address their concerns about COVID-19 vaccines. • Use routine patient reminder call for upcoming visits to share information about vaccine availability in HIV clinics.
M&E	• Harmonize COVID-19 vaccine data collection in HIV and other clinics with the national COVID-19 vaccine M&E system. • Conduct frequent data analysis to inform site-level performance assessments and guide targeted quality improvement. • Generate feedback loops, particularly for poorly performing districts.
Logistics	• Push adequate vaccine supplies to each district based on their estimated target populations with the microplan. • Take inventory of health facility capacity to adequately store COVID-19 vaccines, and use existing infrastructure where possible. • Ensure that HIV clinic vaccine supply is incorporated into the wider health facility request.
Safety	• Provide AEFI training to HCWs. • Strengthen AEFI reporting system within HIV clinics.

*AEFI, adverse event following immunization; HCW, healthcare worker; MCH, maternal and child health; M&E, monitoring and evaluation.