Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4865
Country/Region: Mozambique
Year: 2007
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $4,525,718

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $178,047

This activity is linked to 8588, 8605, 8617, and 8638 activity sheets.

Proposed FY07 funding in this activity will pay 100% of the salary and benefits package of the CDC PMTCT Technical Advisor's position, which is currently vacant. This staff person will provide technical assistance directly to Ministry of Health (MoH) PMTCT program personnel as well as assists the MoH PMTCT team with coordination and guidance provided to USG and non-USG funded NGOs, CBOs and FBOs involved in PMTCT interventions.

The CDC PMTCT Technical Advisor works directly with the MoH HIV/AIDS Program Directors, the Director of the Community Health Department, the Reproductive Health/PMTCT Program Director and PMTCT Program staff on the development and review of National PMTCT program policies, guidelines and training materials, co-facilitates training of trainers, and provides on-the-job mentoring to MOH PMTCT program staff.

This activity also includes funding for short-term technical assistance and travel expenditures for CDC Atlanta PMTCT technical staff during FY07 to assist with the first National PMTCT program evaluation, PMTCT service implementation at maternities, improvement of infant follow-up, and development of activities for increased community and Traditional Birth Attendants' involvement.

Funding for Biomedical Prevention: Blood Safety (HMBL): $15,000

This activity is linked to activity sheets 8196, 8194, 9004, 8612 and 8600.

This activity supports technical assistance visits from CDC Atlanta Blood Safety experts for oversight and coordination of blood safety program support and technical inputs in blood safety trainings, monitoring and evaluation and the Knowledge Attitudes and Perceptions Evaluation regarding barriers to blood donations in Mozambique.

Funding for Care: Adult Care and Support (HBHC): $666,387

Additional funds available through the plus-up will be used in collaboration with CDC Atlanta and the Mozambique Ministry of Health, department of clinical laboratory services and the Mozambique Institute of Health, to develop and implement surveillance of Cryptococcus disease amongst persons infected with HIV. This will contribute to improved treatment and management of Cryptococcosis including Cryptococcus meningitis amongst PLWHA. This activity sheet is also linked to activity sheets 8587, 8570 and 8637.

This FY07 funding request will support technical assistance visits from CDC for final analysis and presentation of findings from assesmments of the feasibility of integrating 1) STI diagnoses and treatment and 2) improved partner services into routine HIV outpatient clinical care.

Part of this request is also to continue an existing GAP 6 mechanism that, at this time, is still being finalized. Funding will be used to develop activities related to a "Best Practices in Integrated Care and Support" document. These best practices were identified in the National Home and Community Care Task Force meeting that took place in August 2006 through the participation of all the major Home Based Care implementing partners and umbrella organizations for implementing CBOs. Some of the policy issues identified included: improved referral systems to multisectoral services, sustainable food security activities, mechanisms for free access to OI treatment, improved monitoring and supervision systems, improved transport systems, caring for carers to prevent burnout, and training for appropriate interaction with community committees. This will incorporate activities related to Traditional Medicine as well.

In addition, funding from this activity will pay 100% of the salary and benefits package of the Home Based Care Specialist and partially fund the Senior Care and Treatment Specialist.

In October 2007 reprogramming, activity funds were reduced by $615,000 in order to support a project with Vanderbilt University - Friends in Global Health.

Funding for Care: TB/HIV (HVTB): $160,305

In Mozambique, the Ministry of Health (MoH) has been taking steps to improve the collaboration between the TB and HIV Programs to better identify and serve dually infected patients. For example, TB registers have been modified and revised to incorporate recording of HIV at the facility-level, established a TB/HIV taskforce that has began to meet regularly on policy issues and guidelines for implementation of TB/HIV collaborative activities

During FY07, the USG will provide technical assistance for implementation of TB/HIV activities and development of standards of care for co-infected adults. Funding in this activity will be used to pay transport and lodging of technical advisors to work with the MOH on the following: (1) TB drug resistance surveillance and treatment, , and (3) monitoring and evaluation. In partnership with the National TB program, USG will support completion of a TB drug resistance survey that includes HIV testing of all patients enrolled. Funds for this survey are available through the Global Fund, but MoH would benefit from technical assistance to ensure timely completion of a nationally representative survey. 2) USG will also assist in providing technical assistance with development of a treatment plan for MDR TB (through assistance with an application to the Green Light Committee) including establishment of MDR centre. (3) Development of a roll-out plan for routing TB screening in all treatment facilities particularly in more remote rural based ART facilities that are being opened in health centres.

In addition, this activity will be used to support the prorated salarsalary of an existing position - Senior Care and Treatment Specialist. One proposed position - Paediatric Treatment Specialist - will be partially funded with the monies in this activity. Both staff will contribute to implementation of TB/HIV activities within USG supported sites as well work at various levels with the MOH in policy and guideline development linked to this area.

Funding for Prevention: HIV Testing and Counseling (HVCT): $211,738

This activity is linked to 8597, 8608, and 8633 activity sheets.

This activity includes the salary for CDC CT Technical Advisor. The CDC CT Technical Advisor works directly with the MoH HIV/AIDS Program Directors, the CT Program Director and the CT Program Trainer on the development and review of National CT program policies, guidelines and training materials, co-facilitates training of trainers, and provides on-the-job mentoring to MOH CT program staff. This activity also includes funding for short-term technical assistance and travel expenditures for CDC Atlanta technical staff during FY07 to assist with the update of the computerized CT program database, advocacy and development of revised national CT program policies, the design and piloting of improved referral systems between CT and care and treatment services, and advocacy for the creation of a formal counselor cadre within the public health care system.

Funding for Treatment: ARV Drugs (HTXD): $49,948

This activity will pay a partial salary and benefits package of an approved, but yet-to-be-filled position - ART Site Coordinator. The remaining funds in this activity will partially pay for a proposed position - Treatment Logistics Specialist. The ARV Drugs program receives significant support from each of these positions to coordinate ARV drug related procurement and quantification activities and to work with partners, other USG agency staff and Ministry of Health officials to avoid stock-outs of medicines. These staff members will also assist in developing national policy and guidelines.

Table 3.3.10:

Funding for Treatment: Adult Treatment (HTXS): $279,709

This activity includes a pro-rated salary a Senior Care and Treatment Specialist. Funds also will be used to partially pay salary and benefits package of two approved, but yet-to-be-filled positions (ART Site Coordinator) Finally, two new positions will be partially paid with funds from this activity - Pediatric Treatment Specialist and Treatment Logistics Specialist. Each of these positions provides or will provide significant support to the ARV Services Program in the area of coordinating ART activities with the Ministry of Health and partners and with particular emphasis on pediatric treatment expansion, commodities procurement, and training.

Funding for Treatment: Adult Treatment (HTXS): $120,000

These funds will support a national Pediatric ART Program Evaluation. Using a retrospective design, a number of selected sites will be purposively chosen for this evaluation. Within each site, a statistically representative sample of the active patient population will be selected to be analyzed. Data abstraction will be performed on medical charts, and where appropriate, interviews will also be conducted with clinic staff and caretakers.

The objectives of this evaluation are: 1. to describe the demographic, clinical, and immunological characteristics of the pediatric ART population; 2. to describe the service provided to them by the National Health System. 3. To describe patient outcomes, including death, rates of follow up, and adherence using routine program data; 4. To characterize common co-morbidities (e.g. tuberculosis) and 5. To document frequency of toxicity or other adverse events. Funds will be used to cover costs of a study manager, protocol development, field staff for data collection, data entry person and logistics.

Table 3.3.11:

Funding for Laboratory Infrastructure (HLAB): $201,275

Funding in this activity will be used to pay partial salary and benefits packages for two a Senior Care and Treatment Specialist. Additionally, the full salary and benefits package of an approved, but yet-to-be-filled position - Senior Laboratory Specialist - will be paid by this activity's funding. Finally, this activity will pay a partial salary and benefits package of a proposed Treatment Logistics Specialist.

In the USG program, each of these positions provides significant support to the Laboratory Infrastructure activities. Work involves coordinating with USG agencies, and implementing partners to assist the MOH to ensure that laboratory reagent and equipment supplies are maintained to support HIV prevention, care and treatment programs; training programs are developed to build human resource capacity in laboratory management and practice and laboratory standards including quality assurance programs are implemented and maintained.

Funding for Strategic Information (HVSI): $1,695,805

Plus-up: Funding will be used to supplement an existing activity to implement a behavioral survey with biomarkers among high risk populations in Mozambique. The plan will involve formative research to identify groups most at risk of HIV infection and then to conduct a survey among those groups about their knowledge, attitudes, beliefs and service use related to HIV/AIDS. We expect that as a component of the behavioral survey, biomarkers (HIV and other STDs) will be included. The additional $100,000 will be used to expand the sample size and perhaps the risk groups sampled depending on the outcomes of the formative research.

Original COP: In Mozambique, few Ministry of Health (MoH) staff and USG partners have the necessary analytical skills to collect and analyze public health data. For this reason, Operations Research (OR) training and the provision of US-based technical assistance (TA) to support two Public Health Evaluations (PHEs), I-RARE and the National ART Evaluation, are proposed in FY07. Additionally, we describe FY07 salary needs in this request to support key SI staff.

1) OR Workshop (50,000): The purpose of this activity is to hold a course that builds capacity in epidemiology and OR using lectures and applied field exercises. During the 6-day class, participants will improve their quantitative and qualitative research skills in epidemiology, protocol design, and using statistical packages. Further, they will see how these skills apply to the epidemiology and control of HIV/AIDS. At the end of the course, participants will develop proposals that may be funded by the USG. For funded protocols, CDC will provide on-going technical assistance to ensure the scientific and ethical integrity of the selected proposals.

Funds for FY07 will cover travel and technical assistance for U.S.-based experts to teach the course, and the adaptation, translation, and reproduction of workshop materials. Funds in FY08 will be requested to fund possible proposals.

2) I-RARE PHE - International Rapid Assessment, Response and Evaluation (200,000): This project is linked to activity 8578. The I-RARE activity in Mozambique will provide MoH and civil society researchers/workers with skills to conduct and analyse qualitative data on hard-to-reach, vulnerable populations. Upon completion of training by the US-based team, researchers and field workers will collect and analyze qualitative data to assess and respond to local health needs. In Mozambique, partners, the MoH and CDC are interested in possibly using I-RARE in drug user and commercial sex worker populations. Information on these groups' behaviours that may make them particularly at risk of infection or impede access to prevention, care and treatment services is very limited.

Funds for this activity will cover travel expenses for facilitators and workshop organization in country and interventions targeting the selected populations, expanding on an initial assessment to be done in FY06. Please see the PHE background and progress report sheets for more information on this activity.

3) National ART PHE (200,000): This project is linked to activities 8941 and 8639.

At the MoH's request, the USG is seeking funds to support a National ART evaluation to measure the quality of ART patient outcomes nationally and at a facility level. Investigators will conduct a 1) retrospective assessment of the reliability and accuracy of routine data collection of key ART program outcomes measures and 2) prospective collection of facility-based quality outcomes indicators. Possible outcomes will include patient retention over time, CD4+ cell count at 6 and 12 months, and viral load suppression at 6 and 12 months based on RNA PCR of residual blood specimens from routine CD4+ testing. Capacity building on monitoring and evaluation and laboratory testing is an important secondary objective of the evaluation. We anticipate that the skills gained by central and facility level staff from this evaluation will contribute to the eventual routine collection of more robust treatment outcomes data, beyond the limited indicators (e.g. number of persons on treatment at the end of the reporting period, number of new patients during the reporting period, number of persons lost in follow-up or death) that are currently reported to the MoH.

Funds for this activity will cover TA from US-based experts to develop the protocol, to train study personnel and to oversee data collection, laboratory testing and analysis. Additional human resources will be hired to work with the MoH as a program coordinator. Please see the PHE background and progress report sheets for more information on this activity.

4) SI Salaries (522,759): The USG requests resources to continue 3 existing CDC positions - IT Manager (partially), Sr. M&E Advisor (fully). The IT manager provides in-office support to the SI team to ensure connectivity and accessibility and security of project data. Additionally, this person aids the MoH in overseeing IT projects to strengthen the health information infrastructure. The senior M&E advisor is a key part of the SI team, assisting all aspects of the SI strategy.

Resources are also allocated for 2 FY06-approved, but vacant positions - Informatics Specialist (fully) and SI Reporting Specialist (fully). The Informatics Specialist will be a key player in advancing the HMIS activities (e.g., facility-level and central level support of electronic medical records.) The interagency SI reporting specialist will support COP planning and semi-annual and annual reports. This position is vital to all USG agencies and partners in responding to the data and information needs of PEPFAR.

Finally, we are proposing 1 new position in this activity - Epidemiological Technical Advisor (fully). This international position will assist the MoH in the collection, analysis and use of routine HIV/AIDS and other communicable disease data reported through the HMIS. This is the first international hire approved to work on the HMIS and will be an invaluable asset to CDC in its support of the MoH.

Funding for Strategic Information (HVSI): $0

Reprogram October 2007 - delete activity

07/07; no sheet no info.

This activity is a continuation of FY06 activity 5245. The activity is linked to activities 9064, 8577 and 8628. The focus is on strengthening systems to reach health care workers and minimize/mitigate the impact of HIV/AIDS on their personal and professional lives. One of the key objectives of the Ministry of Health (MOH) Strategic Plan to Combat STIs, HIV, and AIDS for 2004-2008 is to reduce the impact of HIV/AIDS on health care workers. To date, there are few activities existing that support health workers in dealing with HIV/AIDS. It is unknown how many health workers themselves have undergone testing and counseling or treatment. According to anecdotal information, concerns around confidentiality of information and fears of discrimination within one's work environment are concerns of health care workers when considering whether to access counseling and testing services or treatment. These concerns represent barriers to accessing services, seeking accurate information and examining the risk associated with their personal and professional behaviors. It is unlikely that HIV risk among health workers can be overcome without significant changes to attitudes and behaviors. USG FY06 funding has been supporting the development of an assessment of health workers' current behaviors, attitudes, norms and knowledge (BANK) around primary prevention of HIV, uptake of HIV counseling and testing (CT) and antiretroviral treatment (ART) services, to determine how to better design interventions promoting structured opportunities for educating and assisting health workers to better deal with HIV/AIDS in their work and home environment. The assessment is currently undergoing Ministry of Health human subjects' clearance approval. It will then be sent to CDC for human subjects' clearance approval.

FY 07 funds are being requested to support a TBD partner with experience in the successful development and evaluation of Behavior Change Communication (BCC) interventions in the African context. Activities that this partner will support in Mozambique include: (a) completion of the above described health worker BANK study conducted at MOH health facilities and training institutes; (b) support for data analysis, production and dissemination of the final BANK study report; (c) technical assistance for use of BANK study findings and additional qualitative assessments for BCC intervention design; (d) development of protocols and tools for qualitative assessments, e.g. key informant in-depth interviews and focus group discussions, that will inform the intervention design; (e) evaluation of first pilot interventions to assess their effectiveness at both health facilities and MOH training institutes; and (f) training and on-the-job mentoring of MOH staff from human resources, training, health education departments and HIV/AIDS/STI program in evaluation of behavior change interventions and performance of HIV quantitative and qualitative assessments.

Funding for Management and Operations (HVMS): $947,504

The CDC Mozambique Management and Staffing program is divided among four different mechanisms - 4864, 4865, 4866, 4867. The four activities that contain costs associated with this program are 8512, 8611, 8624, and 8634. The Management and Staffing program supports all administrative costs associated with running the robust portfolio of technical programs, including administrative staff salaries, office costs as well as direct program support through staff and other costs to manage grants and advise program staff on administrative issues.

The CDC office currently has 26 positions under various mechanisms - including four direct hires, 13 locally employed staff and nine contracted staff (COMFORCE, PSC). Three positions are currently vacant, but will be filled in the near future. Each of these positions existed when COP 2006 was submitted with the exception of one administrative assistant which was a proposed position in 2006 and since been filled. We had proposed an additional seven positions at that time, but due to various hiring difficulties - lack of available hiring mechanisms, visa issues with the local government and severe shortage of local human resources, only the administrative assistant position was filled. CDC is currently dealing with these issues on various fronts and hopes that a sound resolution will be found.

In addition to the approved positions from the 2006 COP, CDC Mozambique is proposing 12 technical and administrative positions that will manage the significant increase in activities for 2007 and beyond. They are outlined in the Staffing Matrix.

CDC's office space is currently full with existing staff. In order to accommodate the expected growth in staffing, CDC received approval in the 2006 COP to expand the office to the adjacent space in our existing building. We are in the final stages of the OBO approval process and rehabilitation should begin in the coming months. Funding for rehabilitation was budgeted in 2006.

This activity contains funding for various administrative activities:

- Atlanta paid - Technical Assistance Travel ($135,000) - ICASS Services - CDC currently has 25 employees with proposed staff growth of 19. CDC's ICASS bill for 2006 was $463,833. Since most of the staff growth will be LES or contractors and thus generates less ICASS costs than direct hires, the increase is not linear in nature ($579,791) - State Department Capital Security Cost Sharing - based on actual 2006 bill ($343,625) - Contractual staff salaries and benefits in the amount of 597.011 have been allocated to cover the IT Mgr 75%, Office Manager 100%, Sr. Financial Specialist 100%, Sr Prevention Coordinator, Trainign Specialist, Health Communication Specialist and Treatment Logistics Specialist. Where positions are currently unfilled, salary costs have been apportioned according to the time period in which we expect the position to be filled. ($284,234).

- Contractual and salary costs ($635,823) are also included for the HIV Prevention Specialist, Sr. Prevention Coordinator, Training Specialist, Health Communication Specialist and Treatment Logistics Specialist.

Reprogramming October 2007: $625,000 was allocated away from this activity. The Ministry of Health graduates of the FY06 SMDP management course need logistical support in order to offer their first management training courses. The MOH co-ag has ended, and therefore we cannot move additional into it to support these courses. We are now asking ITECH, along with the technical support provided by them and NASTAD to provide logistical support. Without this support, these courses simply will not occur. The second activity is supporting the development of an in-service training plan/calendar by working with the Training Department and Department of Medical Assistance along with other implementing partners.

Table 3.3.15: