This activity also relates to activity 8593 and OI logistics systems strengthening described in USAID activity 9136 elsewhere in this document.

The main component of this activity is to provide all HIV patients with a minimum package of quality clinical care services at EGPAF's 17 ARV treatment sites. Patients will receive access to this minimum package of care regardless of whether they have initiated ART. Key components of the care package will include:

1) Management of opportunistic infections (OIs) and other acute illnesses: including the prevention, diagnosis and treatment of common oi as well as provision of cotrimoxazole prophylaxis, pain control, facilitating the distribution of bed nets to prevent malaria, as well as site level support for the recording and reporting of opportunistic infections through maintenance of good registers that keep track of a) HIV clinical stage and prophylactic medicines prescribed, b) OIs diagnosed (TB, CM) c) record of adherence to medication and clinic reviews d) specific psycho-social issues requiring follow-up and e) eligibility for ART

2) Provision of psychosocial and adherence support through working with community-based groups and associations and recruitment and training of clinic staff to provide on-going counseling support

3) Assurances of continuity of care services beyond the clinical setting through referral to community-based organizations that serve the respective health facilities. This may include referral to counseling and testing as necessary.

4) Continued patient and family education about HIV disease, OIs, appropriate nutrition and HIV prevention

5) Continued monitoring and regular follow-up to determine readiness and eligibility for initiation of ARV therapy.

To ensure access to all five elements, EGPAF will develop a system for tracking the types of services offered and delivered. Additionally, clinic nurses, clinical officers/medical technicians and pharmacy staff will be trained in the provision of standard HIV care services. Training will include adult and pediatric HIV management and will be provided in coordination with the Ministry of Health.

Through these activities, 13,132 adult and 2,456 children will be provided with clinic-based HIV-related care services during FY07. Children will be identified for care through linkage with PMTCT services, postnatal clinics, in- and out-patient child care services as well as child at risk consultation services. At least 22 community based organizations will be engaged to support referral networks and 300 individuals will be trained in OI management.

This activity is linked to activity 8593 and 8595 which are described in this document and are continuing activities being implemented by EGPAF for the provision of care and treatment services for HIV infected adults and children.

All USG-supported treatment partners, including EGPAF, will be funded to implement TB/HIV activities in HIV treatment settings for adults and children. At a minimum, TB/HIV services will include 1) screening all patients at day hospitals for active TB disease using standardized algorithm, 2) developing a referral mechanisms to ensure that TB suspects are diagnosed with TB and successfully complete TB treatment under DOTS 3) starting cotrimoxazole preventive therapy (CPT) in any HIV-infected person who develops TB disease (irrespective of CD4), 4) implementing plans to reduce nosocomial TB transmission, 5) ensuring that all staff at day hospitals receive training on TB/HIV, including support for dedicated staff for TB/HIV and OI management.

In addition EGPAF will develop linkages with the community groups and TB programs and other USG partners to ensure that adherence support is provided to co-infected individuals, and that monitoring and evaluation systems are in place to track HIV-infected patients at day hospitals who are screened, diagnosed, and treated for TB.

Finally EGPAF will collaborate with existing TB diagnostic and treatment facilities that are closely located the catchments of EGPAF's 17 ART facilities to ensure that: 1) All TB patients in catchment area are offered HIV testing and counseling 2) All HIV-infected TB patients are referred to day hospital for ART evaluation 3) All HIV-infected TB patients are started on CPT (irrespective of CD4);

Also, EGPAF will collaborate with the 11 community organizations in communities nearby EGPAF-supported ARV treatment sites to: 1) Develop/adapt/disseminate IEC materials on TB/HIV 2) Include TB as part of other activities (e.g. treatment literacy)

Plus-up: This activity complements care and treatment activities in the FY07 COP and will support; 1) Training of 225 Mozambican health staff, including medical doctors, nurses and medical technicians on the updated Integrated Management of Childhood Illness (IMCI) curriculum, which includes on module on early identification children with HIV. EGPAF plans to increase the number of children starting treatment by 30 percent - from the initial target of 938 to 1216; 2) Support intensified training of an additional 9 clinicians in pediatric HIV care at the Baylor Centre of Excellence training in Swaziland 3) Hire Consultant to work with the MOH to adapt IEC materials on pediatric ART counseling for use by health facility staff as well as support Reproduction and dissemination of ART counseling materials to distribute to health facility staff; 4) Provide psychosocial support and recreational activities to children living with HIV. EGPAF Mozambique will adapt the model successfully implemented by EGPAF Uganda; 5) Conduct a community awareness campaign on pediatric AIDS in each province to sensitize communities on pediatric AIDS. The objective of this campaign is to facilitate and improve the identification of HIV-infected children and to reinforce linkages to existing OVC programs; 6) Procurement of pill boxes to facilitate adherence to treatment for children and finally to supplement funding of the working meeting convened by the Ministry of Health for Mozambican pediatric health care providers to support the scale-up of pediatric HIV services and integration of these services into the general health care system. This meeting will also serve to review progress and make plans for improving pediatric health care and is scheduled to be held in Maputo in December, 2007.

Original COP: This activity contributes to achievement of ARV treatment services and targets being implemented by other Emergency Plan partners and which are described in activities 8545, 9164, 8547 and 9222 and indirectly in activity 8532.

Project HEART/Mozambique is part of a larger worldwide initiative by the Elizabeth Glazer Pediatric AIDS Foundation (EGPAF) to support HIV Care and Treatment services for PLWHAs in low-income countries. EGPAF's programs help provide a comprehensive family-centered package of PMTCT and ART services for pregnant women, their newborn babies, partners and other HIV infected siblings.

In Mozambique, the number of children receiving ART in Mozambique remains very low relative to the number of adults on treatment (<10% of all ART patients.) For this reason, EGPAF was asked in FY06 to begin expanding pediatric ART services to 8 existing EGPAF-supported PMTCT clinics in three provinces: Maputo (1 site), Gaza (3 sites) and Nampula (4 sites). To accomplish this, EGPAF 1) Recruited 1 ART Technical Advisor based in Maputo (headquarters), and 1 Clinical Advisor for Gaza and Nampula provinces responsible for provision of both technical and programmatic oversight for the ART program; 2) Conducted assessments of infrastructure, laboratory and human resource needs for ART services at the new sites; 3) Used standard training materials developed by the Ministry of Health (MoH) in collaboration with Columbia University to train 11 nurses, clinical officers and doctors in the provision of ART and initiation of ART for 29 patients (by August 2006); and 4) Developed partnerships with community-based organizations for patient referrals, support and follow-up.

With FY06 funds, EGPAF will have provide ARV treatment to 1,263 patients (including 190 children) and will have provided or facilitated HIV care- and treatment-related training of 487 health staff through various training workshops and venues. In addition, EGPAF will complete renovation to the 8 treatment sites.

Proposed activities in FY07 will build on these initial successes and infrastructure to more fully scale-up services at the 8 sites and to expand services to a total of 15 districts and 17 sites (additional 9 sites) in Cabo Delgado, Nampula, Gaza and Maputo Provinces. Specifically with the FY07 funds, EGPAF will:

1) Provide comprehensive care and treatment services for HIV-exposed and infected children and adults, including pregnant women. To deliver these services EGPAF will: a) train health staff in adult and pediatric HIV management b) develop systems to identify early HIV infection and c) ensure access to quality ARV treatment for infants, young children, HIV-infected adults and their families, including pregnant women, at all entry points in the health facility and community. Specific entry points will be PMTCT/Post natal clinics, child-at-risk clinics, IMCI/EPI, in-patient, and TB clinics

2) Implement awareness raising activities for PLWHAs by: a) conducting HIV education sessions for patients infected and affected by HIV, including adequate counseling and dissemination of literacy and IEC materials; b) developing formal agreements with community based groups and organizations to provide HIV related education including Paediatric and Adult treatment, for communities, community leaders, traditional healers and PLWHAs and c) establishing support and referral systems for psycho-social support for PLWHAs, including reinforcement of and linkages with HBC initiatives, nutritional support and patient follow-up.

3) Contribute to sustainable development and building capacity of the health system to provide comprehensive, quality HIV care and treatment services through training and mentoring of staff, and renovation of 5 additional PMTCT sites for ART services and developing referral systems between the ART program and the other HIV services including access to nutrition support and to prevention programs (malaria, EPI).

4) Strengthen monitoring and quality assurance of care and treatment program at all EGPAF supported sites by implementing appropriate user-friendly monitoring and evaluation tools for program reporting and monitoring , including implementing in each district of a computer-based patient tracking system that has already been developed by Columbia University. In addition, EGPAF is willing to participate in the Emergency Plan funded HIVQUAL initiative as and when this program rolls-out to more treatment sites.

By the end of FY07 EGPAF will provide ARV treatment to 6251 people 938 of which will be children. In cooperation with the MOH, CDC, USAID and other in country and international expertise, EGPAF will facilitate or provide training for 487 health workers including nurses, clinical officers and doctors in various aspects of ARV treatment. EGPAF will also continue to participate in coordination meetings of the PEPFAR-funded treatment partners as well as the quarterly PEPFAR partners meetings that encourage sharing of experiences and regular updates to partners.