Plus-up: Columbia university has been funded to implement TB/HIV activities during FY07. Additional funds through the plus-up, will be used to support activities that have been defined as priorities for the National TB program and include the following: 1) Ensure the provision of HIV test kits, cotrimozole, registers and referral forms at TB facilities; 2) Recruit a Technical advisor for the MOH at central level to support health information system design, monitoring and implementation of TB and other HIV related activities

3) Hire a TB data manager to support the MOH National TB program (NTP) monitoring and evaluation as well as implementation of Electronic TB Register 4) increase accessibility to culture and drug susceptibility TB diagnostic services through renovating and equipping a TB culture laboratory in Nampula, in compliance with safety guidelines and standards. This activity complements the renovation activities for the Nampula central hospital laboratory planned in FY06.

Original COP: All USG-supported treatment partners, including Columbia University (CU), 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 and that these data are recorded (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, (6) considering isoniazid preventive therapy in selected patients who do not have TB symptoms, (7) working with existing TB diagnostic and treatment facilities (including OPD and hospitalized TB patients) to expand HIV testing and referrals to care for TB patients, and (8) working with community organizations to enhance the community response to TB/HIV.

In addition to a basic package of TB/HIV activities, CU will implement a number of complementary activities in FY07, including 1) continued support for two TB/HIV model centers, 2) support to the National TB Program and National TB/HIV Task Force, 3) Enhanced TB screening in PMTCT services, and 4) identification of best practices for isoniazid preventive therapy.

1) CU will continue to support two HIV/TB coordinating centers at CU ART facilities that: (1) Develop and evaluate best practices for TB/HIV interventions in the area of clinical management, monitoring and evaluation, training, and coordination with other programs (e.g. through successful referrals to other services), (2) adapt and implement TB infection control strategies for hospital settings, (3) enhance pediatric TB/HIV services, including through implementing family contact investigation and home visiting of HIV-infected TB patients, and (4) provide antiretroviral therapy and HIV care in TB clinic settings. One model center has already been established at Mavalane Hospital in Maputo (an urban site), and a second is being implemented in FY06 at a rural site in Zambezia Province. As CU is a major treatment partner in Zambezia, the model center there will serve as a means of scaling up TB/HIV activities in the province.

2) CU serves as a key treatment partner for TB/HIV activities with the National TB Progam and the MoH. In FY07, Columbia will continue to support the MoH TB/HIV Task Force (Working Group) at the central level, and will work to establish provincial (e.g. Zambezia), district, and facility-level TB/HIV technical committees. Columbia will assist MoH with monitoring and evaluating collaborative TB/HIV activities, including assistance with the rollout of new TB recording and reporting that capture HIV-related data.

3) In FYO7, Columbia will play a leading role in implementing routine TB screening and intensified TB case finding among women enrolled at all ICAP pMTCT sites focusing on: a) Screening all women enrolled at pMTCT sites b) Assuring access to TB treatment facilities for all women diagnosed with TB (regardless of HIV status) c) Training health care workers in management of TB and pregnancy d) Encouraging a family-focused model of approach to care using antenatal care as the point of entry. Lessons learned from these activities will be shared with MoH and other USG-supported partners and used to identify best practices to scale up these activities nationwide.

4) Few HIV patients in Mozambique are receiving IPT. Patients who are eligible for IPT must be carefully screened for TB disease and, once started, must be monitored to ensure treatment adherence and successful completion. In FY07, Columbia will introduce an IPT program at several day hospitals in order to identify best practices for future program scale up. IPT guidelines have been developed, and MoH is planning to expand IPT in the coming year.

Plus-up: This is a provincial focus activity that complements care and treatment activities proposed in the FY07 COP and implemented in Zambezia Province. This funding will support; 1) Strengthened pediatric case finding and follow up treatment through linking with PMTCT, clinical services and OVC programs being implemented in Zambezia and in collaboration with organizations that implement OVC programs 2) Support intensified training of MCH nurses and other health staff involved in child care and follow up and 3) Provide clinical mentoring on pediatric HIV care and treatment for health providers. In addition, the M&E country team will work with the pediatric team to improve the current M&E system of pediatric HIV care and treatment programs and continue to support the MoH in the site supervisions to assure the quality services provided.

COP: This activity is linked to activities 8593 and 8837. CU's proposal for Track 1 and supplemental country funds, described here, build on FY04-FY06 treatment activities. Activities include:

1) Treatment and referral network expansion: CU will support the MOH in the provision of ART to 25,500 PLWHAs (2,500 directly through new supplemental funding) and the expansion & improvement of service referral networks to surrounding communities and health centers. CU will increase its current number of adult HIV care and treatment sites from 18 currently to 24. In FY07, through this proposal, they will further expand to add 12 new facilities, bringing the total number of CU-supported sites to 36. CU will renovate and equip 12 health centers in the provinces of Zambezia, Gaza, Nampula, Inhambane and Maputo. These new facilities will be located in the same districts as larger sites already supported by CU and will form a network of satellite centers for down-referral, follow-up and initiation of ART for patients; in this way CU will expand enrolment even in the rural and remote areas of the country where there is great unmet need. All 12 new facilities will be located in Maputo City, Maputo Province, Nampula City, Quelimane-Mocuba corridor in Zambezia Province, Xai Xai-Manjacaze corridor in Gaza Province and Inhambane-Chicuque in Inhambane Province. Although outside the MoH structure, CU will continue its close collaboration with the Department of Defense to renovate 1 military and 1 police facility in Tete and Maputo provinces, respectively, for the provision of ART among the uniformed forces.

2) Strengthening and supporting scale-up of Pediatric ART and pMTCT-plus for 4,150 children: CU is substantially scaling up its support for pediatric ART in three key areas:

a) CU is committed to ongoing financial, staffing and monitoring and evaluation support to the Pediatric ART facility at Maputo Central Hospital. The Maputo Central Hospital Pediatric Center is currently providing treatment to more than 1500 children and also serves as a training venue for nurses and doctors in pediatric ARV treatment. CU's support to the Center includes staff mentoring, procurement of equipment, supplies and medication, and support for strategic information.

b) CU, through its collaboration with the relevant central managers responsible for national pediatric ARV treatment expansion, will train 80 clinical staff in other ART facilities on the management of pediatric HIV. CU has hired and will maintain the position of a Pediatric HIV Advisor to manage and oversee the expansion of these services to CU-supported sites. This person will serve also as the primary point of contact for this collaboration with the MoH, NGO, and University pediatric treatment partners.

c) The emphasis will be on integration of mother and child care and treatment at the two model centers, increasing the number of infants identified as HIV exposed and/or infected through introduction of early infant HIV diagnosis (1160 children), and improving quality of follow-up for HIV exposed infants through 'at risk consultations' and enhancing referral to care and treatment. 1160 infants will be reached and tested, with an estimated number of 150 requiring and starting ART.

ICAP will continue to support the integration of pediatric services at the model centers, to maximize on PMTCT interventions. Special attention will be given to HIV exposed infants by establishing early infant diagnostic capabilities at the model centers to allow for early identification of HIV infected children, and ensuring they are engaged in care and treatment. Funds will also be used to support and improve the quality of follow-up of HIV exposed infants through active community outreach activities.

Using the model centers as regional training centers, funds will be used to enhance local MCH capacity on pediatric HIV diagnosis and infant follow-up, and recognizing other points of entry in the health system, such as well baby clinic and immunizations. ICAP will also support the national program in integrating pediatric HIV/AIDS diagnosis and care into existing IMCI curriculum and training programs.

Through these efforts, CU will support 4150 children on ART during FY07.

3) Support human resource capacity development and expansion for provision of ARV services: CU will expand its South to South Clinical Cooperation that places CU Infectious Diseases physicians and 24 nurses and psychologists on two-month rotations to 10 HIV care and treatment facilities to conduct on-site training and mentoring for Mozambican clinical staff. Through this program, at least 75 local staff will be trained in various aspects of HIV care and treatment. In addition, CU will continue to provide technical and logistical oversight to the MOH Training Department and DAM to develop and maintain a training program of nurses and clinical officers in the provision of ART. This will be a collaborative effort with the I-TECH that will result in the development of a training plan and the delivery of two trainings of nurses to provide follow-up care to PLWHA.

4) Promoting the provision of adherence and psychosocial support and strengthen the referral networks between the ART with other HIV programs. CU will expand activities to improve treatment adherence at all CU-supported HIV care and treatment facilities. This support includes developing formal linkages with community-based organizations to finance community outreach counselors/activists to follow-up PLWHA at home and to link them with necessary support services. CU will also train clinical staff in adherence and psychosocial support issues as well as facilitate the provision of therapeutic food supplements for patients receiving ART at CU-supported treatment sites. The latter will be achieved by coordinating food distribution with the World Food program (also funded by PEPFAR), renovating food storage and warehouse facilities, and providing nutritional training to CU and clinic staff.

5) Provincial-focused technical assistance to the Zambezia MoH in policy and guidelines development: CU will assist in the expansion of ART services in Zambezia beyond CU-supported facilities by recruiting and seconding the following staff to the provincial Health Authority (DPS): 1 Technical Advisor for planning and facility infrastructure; 1 Technical Advisor for administration and logistics management; 1 Technical Advisor to the TB/HIV/AIDS/malaria provincial coordinator. CU will procure 1 vehicle for site visits to supervise the scale-up of HIV care and treatment in the province. Additionally, CU will help establish a computer network system within the DPS and district hospital through procurement of computers and installation of appropriate software.

6) Coordination: CU will continue to participate in coordination meetings of the PEPFAR treatment partners as well as quarterly PEPFAR partners meetings to ensure exchange of information, coordination of EP efforts and to provide regular updates of the program during the course of implementation.

This activity was originally funded under UTAP. It should have been funded under Track 1 funding for Columbia University, mechanism #4765, because this activity adds to their activity found under activity number 8837.

This activity is linked to 8545, 8532 and 8540 for treatment services, reagents and equipment supplies and laboratory technician training and quality assurance.

Columbia University (CU) has been implementing ART services in five provinces, both in the major provincial hospitals as well as small district hospitals and health centers. In addition CU contributes to infrastructure development through renovation of health facilities for provision of ART. During FY07 CU will expand services to 9 new treatment sites and will renovate and provide necessary supplies and furniture for 9 laboratories that are attached to health centers to ensure that appropriate laboratory services are available for the follow-up of patients on ART in these areas. A good electricity supply, water source and drainage, lab benches, computers and furniture are all considered within the spectrum of support that CU will provide. Part of this funding will also support the salaries of staff responsible for the oversight of CU laboratory projects

APHL will equip and supply hematology, biochemistry and CD4 equipment as needed to these laboratories depending on facility type as well as manage the supply of reagents and equipment maintenance. The Ministry of Health, in collaboration with other Emergency Plan partners, will recruit and provide training of laboratory personnel needed to manage these laboratories.