Plus-Up Change: EGPAF will start PMTCT services in an additional 9 sites: 3 in Cabo Delgado, 2 in Nampula 1 in Gaza and 2 in Maputo. The sites include the following health centers: Nametil, Mossuril, Incaia, Campoane, Belleluane, and Ressano Garcia. The sites for Cabo Delgado are, tentatively, Palma, Nangade, Muidumbe, This expansion of PMTCT services aims at making essential services for the prevention of pediatric AIDS available in more remote settings. In Cabo Delgado and Nampula this implies expansion into additional districts where currently no PMTCT services are available. In Gaza and Maputo, EGPAF will move into additional peripheral sites to ensure increased coverage of PMTCT services in these high prevalence provinces. In these new sites, EGPAF will reach an additional 4,800 women with HIV testing services during pregnancy and aims to provide ARV prophylaxis to an additional 360 HIV positive women. Support will include basic and on the job training in PMTCT and counseling and testing, formative supervision and technical support to clinical services as well as psychosocial services for identified HIV positive women, including support to the establishment of support groups. Throughout the program, greater emphasis will be placed on primary prevention among women testing HIV-negative. EGPAF will also work to increase rates of exclusive breastfeeding, as a strategy to reduce pediatric infections but also improve the health off all children in these settings with high rates of malnutrition and infant mortality. Finally, EGPAF will hire a PMTCT technical advisor for the province of Cabo Delgado to assist the DPS in improving the quality and quantity of PMTCT services within the province, especially in sites that receive no direct NGO support. EGPAF will support the provincial PMTCT advisor with funds to assist in supervisory visits, petrol, and communications.

FY06 program goals for EGPAF/Mozambique focused on 1) support to the Mozambique National PMTCT program 2) use of PMTCT to identify HIV infected individuals, and to link to care and treatment services for families; and 3) strengthening of MCH services, especially capacity building at the Provincial and District level health care system. During 2006 PMTCT services were supported in 18 sites, including three referral maternities. As of June 2006 the Foundation's PMTCT program has provided 23,830 women with HIV counseling and testing, identified 3,136 as HIV positive, provided 1,533 HIV positive pregnant women with ARV prophylaxis and 1,608 HIV exposed infants with ARV prophylaxis. In 8 of the supported sites, treatment programs were established with support from the Foundation (USG/CDC funds), increasing access to ARV treatment for pregnant women in need of treatment and HIV infected infants and children. For FY2007, EGPAF is requesting funds from USAID for the continuation and expansion of PMTCT services as well as funds from CDC to continue to provide antiretroviral treatment (ART) with a family focused approach and to expand to additional sites. This expansion of ART programs include the planned new PMTCT sites so that comprehensive PMTCT programs will also provide access for ARV treatment for pregnant women and mothers who need this for their own health. The presence of an ART program in these sites will also facilitate the provision of more complex and effective prophylactic regimens. The Foundation's plans in FY07 are to continue providing comprehensive PMTCT services in existing sites with a focus on improving quality of services and increasing coverage by supporting the DDS to expand into peripheral sites within district programs. In addition, during the next year the Foundation plans to expand into Moamba District in Maputo Province and Nametil District in Nampula province and add four sites in Cabo Delgado. Technical assistance and support will focus on improving monitoring and evaluation systems and moving to provide routine counseling and testing in both the antenatal care and labor and delivery settings in all sites. The Foundation's PMTCT program will continue to provide a comprehensive package of care and will work to accelerate implementation of key services including the provision of more complex prophylactic regimens for HIV positive women with CD4 counts over 350, integration of family planning, malaria prophylaxis and TB screening services and further emphasis on improving HIV positive eligible women's access to ART. Improving health work skills in staging and screening patients will help decrease loss to follow-up. Follow up of mother and infant pairs will also receive increased attention. The Foundation staff will provide technical support to the Mozambique MOH for the revision of the national child health card. The new card designs will capture information on HIV exposure. In addition, identification of HIV exposed infants will be improved by training staff in well child clinic (WCC) to look for HIV exposure status on the infant card and inquire if status is missing.

Improvement of the Child at Risk Clinic (Consultas de Crianças em Risco) will also continue for follow up care of HIV infected mothers not eligible for ART at CCR. Early identification of HIV exposed infants will allow early testing and identification of HIV infected infants and timely initiation of treatment services and ultimately lower morbidity and mortality rates for these children. Therefore the Foundation will provide support to the roll-out of DNA-PCR into its supported sites as per MOH implementation strategy. Mother infant pairs who do not return to formal health services will be followed up in the community by volunteers from the Community based organizations that the Foundation has started to support in FY2006. The Foundation will continue to strengthen existing Mozambican community-based organizations (CBO) to mobilize for PMTCT and provide support to HIV positive pregnant women, infants and their families. The CBO's provide community sensitization and mobilization activities regarding PMTCT and ART services and link HIV positive mothers and their families to additional sources of support. The CBO's also provide critical follow up activities, actively finding defaulting mother/infant pairs and encouraging them to timely access MCH services. CBO's are an important information dissemination mechanism planned for the results of the targeted evaluation on early cessation of breastfeeding through their mother/family support groups. Additional support activities will be introduced to provide a comprehensive package of care services within the PMTCT program. The Foundation will support the provision of ITN and IPT for malaria control to all pregnant women in ANC. With UNICEF funding, EGPAF in FY06 began providing PMTCT services in sites in Cabo Delgado including a pilot activity using PlumpyNut for HIV exposed infants to support early breastfeeding cessation after 6 months. If additional funding for PlumpyNut is identified, it may be possible to expand this activity to other sites. As the prevention of unintended pregnancies is a core strategy of PMTCT, the Foundation will implement specific activities to strengthen Family Planning services within the PMTCT program. This will include the training of health staff aimed at strengthening Family Planning services within PMTCT, the roll out of the FSG manual (developed in FY06) which includes a module on FP, and improve the inclusion of men by couples counseling in ANC and maternity. Continued support to MOH/DPS will be provided for M&E and quality assurance of the different program components, including support to the establishment of a computerized information system in each district and continued support to district level PMTCT/ART taskforces established in 2006.