Plus-up change: Utilizing plus up funds PSI will research, develop, and test new IEC and BCC campaign materials surrounding PMTCT, male involvement in PMTCT, and male testing, emphasizing a family-centered approach. PSI will also be responsible for creating and reproducing these new campaign materials for nationwide distribution. Further, PSI will adjust their current PMTCT materials to reflect new PMTCT policy guidance and reproduce these materials in Portuguese and two other national languages. the IEC/BCC campaigns are costed at $700,000. This campaign should also be reproduced for nationwide distribution. Finally, PSI will map existing PEPFAR and non-PEPFAR PMTCT interventions and overlay this map with mosquito net distribution data from the President's Malaria Initiative (PMI) and other donors and partners. This assessment will be a gaps analysis of where PEPFAR, PMI, and other partners are complimentary and where, geographically speaking, more action is needed by the consortia of actors ($150,000). This activity is related to other PSI activities in C&OP 9150 and CT 9114. PSI will continue to provide technical support to MOH sites to scale up PMTCT activities in 3 provinces and Maputo City. PSI will deliver a complete package of PMTCT services in line with MOH policies and protocols, including routine CT, provision of Nevirapine to seropositive mothers and their newborns, and provision of integrated postnatal services. PSI will renovate facilities, train counselors, and track seropositive mothers and their infants for 18 months postnatal. Additional focus will be placed on improving the delivery environment to increase the number of institutional deliveries, and thus the number of seropositive mothers receiving nevirapine. Each site will counsel and test at least 90% of first-time antenatal attendees. PSI will continue to support the 19 PMTCT sites initiated with USG funding between 2003 and 2006, and will add 3 additional sites through training of nurses and counselors and in collaboration with the MOH. PSI will continue to implement community-level activities to reduce fear and social stigma among seropositive pregnant women and mothers, focusing on key decision-makers in their lives (e.g., husbands, mothers-in-law). Seropositive pregnant women will be referred to the nearest HIV/AIDS care and treatment site for additional needed services prior to delivery. PSI will continue to disseminate a package of PMTCT communications materials developed with, and implemented through, the MOH and all PMTCT implementing partners, and in coordination with the Johns Hopkins CCP USAID/PMTCT/9162 communication activity. Additionally, the MOH has set ambitious targets for provision of bednets and IPT for ANC, and PMTCT will benefit from this program. However, it will take some time for the malaria initiative to get up and running, and for bednets and IPT to flow to all parts of the country. PSI should plan for a 3-6 month supply of bednets and IPT to assure that the minimum package of PMTCT includes these malaria interventions.

This activity is related to Activity 9150, PSI's C&OP activity.

This activity is the AB component of an ABC behavior change communications activities for uniformed services. $150,000 will support activities for Military recruits and $50,000 will support activities for Police recruits. We know from experience that AIDS is more than a health issue: it is now a global security concern. In countries like Mozambique, AIDS epidemic proportions, it is devastating whole regions, knock decades off national development and destroying what constitutes a nation: the communities, the economy, the political institutions, and even the military and police forces. In many countries the pandemic has affected uniformed personnel far more than civilian populations.

Every year around 4,000 recruits aged 18-25 are drafted into the Mozambican armed forces for a 2 years mandatory period of service. The majority of recruits are from rural areas where education about HIV/AIDS/STI prevention is almost entirely absent. Inadequate information received in high schools, prior to military service, also explains recruits' poor knowledge of HIV/AIDS/STI and their risky behavior patterns.

Uniformed services, including defense and civil defense forces, are highly vulnerable to sexually transmitted infections (STIs), mainly because of their work environment, mobility, age and other facilitating factors that expose them to higher risk of HIV/AIDS infection. It is also known that there is a correlation between low education, low information and HIV. Those who have more access to information are better protected.

Providing information alone is not enough. There is a need to change attitudes and, the young recruits will be the agents of this change since they are particularly important in view of their potential role as future leaders and decision-makers, and as peacekeepers in their own countries and elsewhere. Young soldiers are also often seen as role models among their peers, and could serve as agents for change not only within the military/police forces but also in their communities. The behavior of young recruits and the services and information they receive determine the quality of life of millions of people. Therefore, the military young recruits will be targeted with mostly AB messages, during the 3 months training period in the two training centers (Manhiça - Maputo and Montepuez - Cabo Delgado) and when assigned to definitive posts at various military bases. A specific program will be implemented in the Police Academy (ACIPOL) targeting the students with messages about Abstinence, Faithfulness during the training period.

During the course of military service soldiers may increasingly be exposed to alcohol and drugs, and become involved in various forms of risky behavior, such as sex with casual partners, injecting drugs and alcohol use. This is particularly the case in regions where drug and alcohol consumption are high: industrial centers, seaports, cities, places with high levels of unemployment, etc. Therefore the activity implementing partner will also reinforce peer education, BCC, IEC, in # police squadrons along the country and in all military bases especially the sites targeted during the prevalence and behavioral study. This activity will include theatre presentations, production & distribution of informative material (pamphlets, booklets, stickers, etc).

Targets 4,000 Military recruits reached with AB 1,000 Police recruits reached with AB

50 Military recruits trained to promote AB 15 Police recruits trained to promote AB

This activity is linked to PSI activities in CT 9114 and PMTCT 9141. PSI will continue to provide logistics and technical support for condom social marketing (CSM) targeting most-at-risk groups, within the context of a number of behavior change communication (BCC) activities targeting youth and adults of reproductive age in all 11 provinces of Mozambique (including Maputo city). This program is a key element of the comprehensive BCC program in Mozambique, that includes abstinence, delayed sexual activity for youth, partner reduction among adults, and promotion of faithfulness. Prevention activities using CSM are closely linked to PSI's work in PMTCT, CT, and promotion of timely clinical treatment of STIs. The program ensures wide availability of condoms through large and small commercial outlets and non-traditional outlets, interpersonal communications for risk reduction, mass media messages, and design, production, and distribution of print materials for health workers and targeted high-risk populations. PSI will maintain CSM distribution while increasing coverage in outlets frequented by most-at-risk groups. BCC messages on radio will encourage sexually active adults to remain faithful to one partner and otherwise to make consistent use of condoms. Young couples and sexually active youth are encouraged to prevent both unwanted pregnancies and transmission of STIs, including HIV, through condom use. PSI will continue to implement program monitoring and assessment activities to ensure that target audiences are responding appropriately to the BCC and CSM campaigns and reducing the number of high-risk sexual encounters. Channels of communication include TV and radio broadcasts and print media, selected in different provinces to match the demographic characteristics of urban and rural populations. Interactive peer education techniques are used with special target groups including pregnant women, mobile youth, and uniformed services personnel. PSI has developed several professional teams of local actors who use folk media including drama and audience participation to achieve behavior change. PSI will continue to implement and expand a specially targeted BCC strategy utilizing peer educators selected from among young police recruits. These recruits become mentors and positive role models to male youth in towns and urban areas. In FY07, these activities will be expanded to three new provinces, chosen in collaboration with the Ministry of the Interior. The objective of this component is to emphasize the value of male peer support in today's high-risk environments and to empower young males to help mentor and nurture other male youth to reduce their risky behavior. Special IEC materials targeting young police will be adapted from similar materials already developed for the military program. PSI also will support the Ministry of the Interior to develop an HIV prevention strategy to guide the work with police officers over the next 5 years. In 2007, PSI will intensify an existing USG-supported BCC program among the military that was initiated in 2004 with DoD funding and continued with Emergency Plan funding in FY05. Activities include interpersonal peer education and establishment of HIV/AIDS information resource centers. PSI will work on increasing the Mozambican military's capacity in continuing peer educator programs, as well as strengthening revising an STI management program. The Ministers of Defense and Interior as well as high rank commanders from both ministries will record (video and audio) appropriate prevention messages to be transmitted in military bases and police squadrons [military $150,000; police $50,000]. PSI will continue workplace BCC programming that seeks to provide holistic ABC programming with linkages and referrals for care and treatment.

This activity relates to another PSI activity in HIV treatment services, HTXS 9166.

This activity duplicates other activities because water and nets will be provided to currents clients of OVC and ART services. Therefore, no separate targets are provided.

This activity contains two components: Safe Water Systems (SWS) and Insecticide Treated Nets (ITN).

In FY06, PSI is implementing a successful program to make household-level Safe Water Systems (SWS) available to 2,208 OVC and their caregivers and 5,000 PLWHA (at $.25 per bottle x 12 bottles per year) (under the treatment activity). This program will continue in FY07 reaching 4,000 OVC and their caregivers and 85,000 PLWHA on ART. The SWS consist of small bottle of solution to purify water for a one month period for a family. The program will reach OVC and PLWHA on treatment and provide them with SWS through linking in to the HIV/AIDS care and support services available in both clinic and community settings under the integrated networks (e.g. home-based care, OVC services, PMTCT, ART).

Using PSI traditional social marketing techniques, this activity will scale up marketing and distribution activities in the six target provinces. As distribution is pushed out through wholesalers and smaller retail outlets, a series of radio, billboard and other mass media campaigns to increase awareness of this new product will be launched. This product will be available for anyone to buy on a regular basis. Simultaneously, the USG NGO partners working in OVC and treatment services specifically aimed at treatment adherence will be provided with a one-day training. They will learn the essential facts about diarrheal disease and transmission, its links to HIV/AIDS, the importance of prevention and treatment of diarrhea, and correct use of the SWS. The social marketing and availability of the product will minimize stigma and discrimination of those that receive the product free.

The second component will target the distribution of 27,000 ITN's to OVCs under five years of age and their caregivers in PEPFAR target provinces in addition to 85,000 PLWHA registered at Day Hospitals (at $8 per net). PSI will implement the program by making the nets available to USG NGO partners implementing OVC and treatment adherence activities outside of the PMI geographical areas. PSI will provide training in usage of the nets and in the importance of protecting oneself against malaria. This includes consistent use of nets, cleaning up around the household and removing all stagnant water from surrounding areas.

The Ministry of Women and Social Action (MAS) supports the use of nets for all children because of their effectiveness to help ward off the threat of malaria which can be detrimental to children, particularly those under five years of age. Because of their importance in deterring malaria, MMAS included ITNs as a requisite item in their OVC costing exercise and encourages NGOs, CBOs, PVOs to assist in the provision and distribution of nets. This activity will support a mere portion (27,000) of ITNs needed.

Plus-up: Utilizing plus up funds PSI will research, develop, and test new IEC campaign materials surrounding the new testing and counselling for health strategy (ATS). The materials will also target the new opt-out and integrated counselling and testing strategy, which is expected to positively enhance scale-up opportunities. The strategy and approach is currently in the first phase of implementation so materials will be reproduced on a limited basis to cover those areas where ATS is currently underway.

Original COP: This activity is related to C&OP 9150 and MTCT 9141.

PSI will continue to provide technical support to 27 existing CT sites in MOH health facilities, and will scale up CT services in approximately 35 satellite sites. Both provider-initiated and client-initiated CT will be implemented, as MOH staff receive planned training in provider-initiated CT. Satellite expansion will take place primarily in the populous and high-prevalence Zambezia province. PSI will follow and support the MOH's new policy, and work with the local health departments to implement a community CT program. PSI will train counselors, rehabilitate facilities, and deliver a complete package of CT services in line with MOH policies and protocols. PSI will work to reduce social stigma that affects PLWHA, and will train counselors and make minor structural adjustments to accommodate "satellite" counseling in rural health facilities. Through theatrical performances and radio spots, adults including uniformed services personnel and older youth will be mobilized to take advantage of HIV CT. PSI also will continue to collaborate with the Ministry of Defense to build capacity for providing CT (as well as other HIV/AIDS services) at military health facilities. PSI will continue to provide CT services to military personnel at 7 sites established with FY06 funding, in Maputo, Tete, Sofala, and Manica, Zambezia, Niassa, and Nampula provinces. With FY07 resources, two new military CT sites will be established, in Cabo Delgado province and one to be determined with the Ministries of Health and Defense. CT training will be carried out for military nurse-counselors. All military health facilities also provide services to families of the troops and to civilians in nearby communities, so the CT services at military sites reach a larger target population than the troops themselves. PSI will also working with the Ministry of Defense to expand the satellite CT program to approximately two sites out of each military hospital with a PSI-supported fixed site.

Through these efforts a total of 72 CT outlets will be established, 110,000 people will receive CT and 90 people will be trained.

This activity relates to HKID 9149 and all HKID and HBHC activities. This activity duplicates other activities because water and nets will be provided to currents clients of OVC and ART services. Therefore, no separate targets are provided.

PSI will continue to implement a program to make household-level Safe Water Systems (SWS) available to 4,000 OVC and their caregivers and 39,500 PLWHA on ART (at $.25 per bottle x 12 bottles per year). The SWS consist of small bottle of solution to purify water for a one month period for a family. The program will reach OVC and PLWHA on treatment and provide them with SWS through linking in to the HIV/AIDS care and support services available in both clinic and community settings under the integrated networks (e.g. home-based care, OVC services, PMTCT, ART).

Using traditional social marketing techniques, this activity will scale up marketing and distribution activities in the six target provinces. As distribution is pushed out through wholesalers and smaller retail outlets, a series of radio, billboard and other mass media campaigns to increase awareness of this new product will be launched.

Simultaneously, the USG NGO partners working in OVC and Treatment services specifically aimed at treatment adherence will be provided with a one-day training in which they will learn the essential facts about diarrheal disease and transmission, its links to HIV/AIDS, the importance of prevention and treatment of diarrhea, and correct use of the SWS.

The activity will also target the distribution of 27,000 ITN's to OVCs under five years of age and their caregivers in PEPFAR target Provinces in addition to 85,000 PLWHA registered at Day Hospitals (at $8 per net). The Ministry of Women and Social Action included ITNs in their costing exercise when determining the average cost per client for caring for OVC and encourages NGOs, CBOs, PVOs to assist in the provision and distribution of nets. The ITNs help ward off the threat of malaria which can be detrimental to children, particularly those under five years of age. PSI will implement the program to make the nets available to USG NGO partners implementing OVC and treatment adherence activities at the same time providing training in usage and importance of protecting oneself against malaria which includes using nets, cleaning up around the household and removing all stagnant water from surrounding areas.