The level of knowledge about the risk of a HIV positive mother infecting her child is low, and more so in rural areas and among poor women and women with no formal education. Utilization of PMTCT services is observed to be higher in and around provincial capitals, access for women living in remote villages is limited due to poor infrastructure and long distances to PMTCT sites. CARE Mozambique is proposing to strengthen MoH PMTCT services at 3 rural district health facilities in Vilankulos, Mabote and Inhassoro where clinical PMTCT services have recently been initiated but with low capacity to reach women of reproductive age facing difficulties in accessing HIV/AIDS services, including PMTCT and ART in case of HIV infection. Support will include improved and increased access to prophylaxis such as nevirapine for HIV-infected pregnant women from rural facilities with inadequate health care systems and to-date limited access to HIV counseling and testing (CT) services. For example in Mabote, the VCT services are located far from the main health facility where antenatal and other reproductive health services are provided. As staff capacity and motivation are low, training and on-the-job support will be critical. A comprehensive package of PMTCT services and interventions will be provided to help uninfected women to stay negative, to lower the risk of HIV transmission to children from HIV-infected mothers, and to support HIV-infected mothers and babies. On-the-job training will be provided to nurses and doctors on up-dated PMTCT and pediatric AIDS treatment protocols, counseling and infant feeding among other topics. The proposed project will create and strengthen linkages between the PMTCT and ART services to increase access to AZT for pregnant women and as a result reduce child morbidity and mortality. Moreover HIV-infected mothers are faced by the burden associated with their own infection, therefore attention will be paid to preserving the health of HIV-infected mothers after they give birth to ensure the continued survival of their infants. The support to PMTCT services will include reaching mothers in maternity wards for counseling and testing for those who missed the opportunity during the antenatal period, and hence increase access to HIV counseling and testing as well as prophylaxis or treatment when necessary. Health promotion and education on family planning, breastfeeding and nutrition will be an integral aspect of prevention intervention to be provided to HIV-infected pregnant women, mothers and their families. Women are often afraid to access CT and ART because they fear being ostracized by their partners, family and friends. As in Mozambique, HIV-related stigma is a critical issue, that hinders continued utilization of services, the project will introduce male participation in PMTCT and counteract stigma by supporting community information campaigns and increase male support for HIV-infected women in order to reduce drop outs, as well as educate HIV-infected women from the antenatal to postnatal period to increase adherence among PMTCT clients to treatment and care. More than 60% of pregnant women in rural areas deliver at home. The project will, in collaboration with MOH district level staff, identify Traditional Birth Attendants (TBAs), known to provide antenatal and delivery services to women from the targeted rural areas and will provide basic PMTCT training and establish referral linkages with PMTCT sites for CT and ART. Beyond reinforcing linkages between clinical and community interventions, the project will assist Positive Mothers to form support groups to provide mother-to-mother support, for community level counseling, encourage women to deliver in health facilities rather than at home, as well as help pregnant HIV-infected women to adhere to PMTCT services.