Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3526
Country/Region: Mozambique
Year: 2008
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $3,300,040

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $133,948

Continuing activity:

Proposed funding under this activity supports the salary and benefits package of the CDC PMTCT

Technical Advisor's position. The CDC PMTCT Technical Advisor works directly with the MoH HIV/AIDS

Program Directors, the Director of the Community Health Department, the Reproductive Health/PMTCT

Program Director, and PMTCT Program staff on the development and review of National PMTCT program

policies, guidelines and training materials, co-facilitates training of trainers, and provides on-the-job

mentoring to MOH PMTCT program staff.

The PMTCT Advisor also co-chairs, with the USAID CT&PMTCT CTO, the USG PMTCT Partners' working

group, that meets every two months, to exchange information and PMTCT materials developed by

individual partners, to discuss PMTCT implementation challenges encountered across partners, to develop

plans and provide recommendations as to overcome these challenges. The PMTCT Advisor facilitates

linkages between the MOH PMTCT team and the USG PMTCT implementing partners.

While the M&E Advisor is not funded through this activity, the PMTCT and M&E Advisors work together to

provide technical assistance and inputs relevant to M&E aspects of the PMTCT program, including

improvements in regards to PMTCT data compilation, analysis, and use of PMTCT data, improvement of

PMTCT M&E registers and tools.

FY07:

This activity is linked to 8588, 8605, 8617, and 8638 activity sheets.

Proposed FY07 funding in this activity will pay 100% of the salary and benefits package of the CDC PMTCT

Technical Advisor's position, which is currently vacant. This staff person will provide technical assistance

directly to Ministry of Health (MoH) PMTCT program personnel as well as assists the MoH PMTCT team

with coordination and guidance provided to USG and non-USG funded NGOs, CBOs and FBOs involved in

PMTCT interventions.

The CDC PMTCT Technical Advisor works directly with the MoH HIV/AIDS Program Directors, the Director

of the Community Health Department, the Reproductive Health/PMTCT Program Director and PMTCT

Program staff on the development and review of National PMTCT program policies, guidelines and training

materials, co-facilitates training of trainers, and provides on-the-job mentoring to MOH PMTCT program

staff.

This activity also includes funding for short-term technical assistance and travel expenditures for CDC

Atlanta PMTCT technical staff during FY07 to assist with the first National PMTCT program evaluation,

PMTCT service implementation at maternities, improvement of infant follow-up, and development of

activities for increased community and Traditional Birth Attendants' involvement.

Funding for Biomedical Prevention: Blood Safety (HMBL): $10,000

Continuing activity: Funding under this activity is proposed to support in-country travel for the CDC Senior

Prevention Program Advisor assisting with coordination, supervision, technical assistance, Monitoring and

Evaluation (M&E) of blood safety activities in Mozambique. The Advisor meets with the Mozambique MOH

National Blood Transfusion Program (NBTP) staff at least monthly, and accompanies visits from the

technical assistance Provider, the American Association of Blood Banks (AABB) that take place in support

of training, supervision, on-the-job mentoring. The Advisor is on occasions also asked to accompany NBTP

staff to regional events to assist with presentation of Mozambique's blood safety activities and participation

in planning and program review occurring as part of these meetings.

Funding for Care: Adult Care and Support (HBHC): $233,115

Additional funds available through the plus-up will be used in collaboration with CDC Atlanta and the

Mozambique Ministry of Health, department of clinical laboratory services and the Mozambique Institute of

Health, to develop and implement surveillance of Cryptococcus disease amongst persons infected with

HIV. This will contribute to improved treatment and management of Cryptococcosis including Cryptococcus

meningitis amongst PLWHA.

This activity contributes to partial salary and benefits for the CDC Medical Epidemiologist and the full salary

and benefit support for the CDC Home-based Care Technical Advisor.

The Medical Epidemiologist will provide leadership in activities related to Opportunistic Infections and

TB/HIV program managment, participate in MOH, Inter-Agency, and TB/HIV Task Force meetings,

supervise TB/OI and Home-based care activities (including supervising 3 staff who work closely with MOH

on these issues), supervise cooperative agreement with Mozambique's Ministry of Women and Social

Action and lead the development and implementation of public health evaluation activities related to care

and treatment.

The Home-based Care Technical Advisor oversees and coordinates Home-based Care activities in the

MOH, Integrated Care and Support activities with MMAS and provides technical inputs to ANEMO's

(Mozambican Nurses Association) palliative care related activities and related public health evaluations and

systems development activities being carried out by various partners.

This activity sheet is also linked to activity sheets 8587, 8570 and 8637.

This FY07 funding request will support technical assistance visits from CDC for final analysis and

presentation of findings from assesmments of the feasibility of integrating 1) STI diagnoses and treatment

and 2) improved partner services into routine HIV outpatient clinical care.

Part of this request is also to continue an existing GAP 6 mechanism that, at this time, is still being finalized.

Funding will be used to develop activities related to a "Best Practices in Integrated Care and Support"

document. These best practices were identified in the National Home and Community Care Task Force

meeting that took place in August 2006 through the participation of all the major Home Based Care

implementing partners and umbrella organizations for implementing CBOs. Some of the policy issues

identified included: improved referral systems to multisectoral services, sustainable food security activities,

mechanisms for free access to OI treatment, improved monitoring and supervision systems, improved

transport systems, caring for carers to prevent burnout, and training for appropriate interaction with

community committees. This will incorporate activities related to Traditional Medicine as well.

In addition, funding from this activity will pay 100% of the salary and benefits package of the Home Based

Care Specialist and partially fund the Senior Care and Treatment Specialist.

Funding for Care: TB/HIV (HVTB): $35,345

Funding in this activity will support the partial salary for the CDC Medical Epidemiologist who will provide

leadership in activities related to Opportunistic Infections and TB/HIV program managment, participate in

MOH, Inter-Agency, and TB/HIV Task Force meetings, supervise TB/OI and Home-based care activities

(including supervising 3 staff who work closely with MOH on these issues), supervise cooperative

agreement with Mozambique's Ministry of Women and Social Action and lead the development and

implementation of public health evaluation activities related to care and treatment.

In addition, this activity will provide partial salary and benefits packages for the Paediatric Treatment

Specialist, the Care M&E Officer, and the (OI) TB/HIV Specialist. Finally, the full salary and benefits

package for the OI Advisor will be paid through this activity.

In Mozambique, the Ministry of Health (MoH) has been taking steps to improve the collaboration between

the TB and HIV Programs to better identify and serve dually infected patients. For example, TB registers

have been modified and revised to incorporate recording of HIV at the facility-level, established a TB/HIV

taskforce that has began to meet regularly on policy issues and guidelines for implementation of TB/HIV

collaborative activities

During FY07, the USG will provide technical assistance for implementation of TB/HIV activities and

development of standards of care for co-infected adults. Funding in this activity will be used to pay transport

and lodging of technical advisors to work with the MOH on the following:

(1) TB drug resistance surveillance and treatment, , and (3) monitoring and evaluation.

In partnership with the National TB program, USG will support completion of a TB drug resistance survey

that includes HIV testing of all patients enrolled. Funds for this survey are available through the Global

Fund, but MoH would benefit from technical assistance to ensure timely completion of a nationally

representative survey.

2) USG will also assist in providing technical assistance with development of a treatment plan for MDR TB

(through assistance with an application to the Green Light Committee) including establishment of MDR

centre.

(3) Development of a roll-out plan for routing TB screening in all treatment facilities particularly in more

remote rural based ART facilities that are being opened in health centres.

In addition, this activity will be used to support the prorated salarsalary of an existing position - Senior Care

and Treatment Specialist. One proposed position - Paediatric Treatment Specialist - will be partially funded

with the monies in this activity. Both staff will contribute to implementation of TB/HIV activities within USG

supported sites as well work at various levels with the MOH in policy and guideline development linked to

this area.

Funding for Prevention: HIV Testing and Counseling (HVCT): $205,410

Continuing activity: This activity continues support for salary and benefits for a CDC Counseling and Testing

(CT) Technical Advisor providing technical assistance directly to Ministry of Health (MOH) CT program

personnel as well as assisting the MOH CT team with coordination and guidance provided to USG and non-

USG funded NGOs, CBOs and FBOs involved in CT interventions and service delivery.

The CDC CT Technical Advisor works directly with the MOH HIV/AIDS Program Directors, the CT Program

Director and consultants on the development and review of National CT program policies, guidelines and

training materials, co-facilitates training of trainers, and provides on-the-job mentoring to MOH CT program

staff including improvements in regards to CT data compilation, analysis and use of CT data, CT program

reports, the creation/improvement of CT M&E registers and tools.

In addition, this activity provides partial salary and benefits support for the Medical Epidemiologist which is

shared across Palliative Care, TB/HIV and CT programs.

FY07: This activity is linked to 8597, 8608, and 8633 activity sheets.

This activity includes the salary for CDC CT Technical Advisor. The CDC CT Technical Advisor works

directly with the MoH HIV/AIDS Program Directors, the CT Program Director and the CT Program Trainer

on the development and review of National CT program policies, guidelines and training materials, co-

facilitates training of trainers, and provides on-the-job mentoring to MOH CT program staff. This activity also

includes funding for short-term technical assistance and travel expenditures for CDC Atlanta technical staff

during FY07 to assist with the update of the computerized CT program database, advocacy and

development of revised national CT program policies, the design and piloting of improved referral systems

between CT and care and treatment services, and advocacy for the creation of a formal counselor cadre

within the public health care system.

Funding for Treatment: ARV Drugs (HTXD): $116,307

Funding in this activity supports the partial salaries and benefits for two positions: The senior treatment

Coordinator and the ART site Coordinator.

The Senior treatment coordinator: Is responsible for USG-supported HIV treatment scale-up, chairs the

USG Interagency Treatment Working Group, is the main liaison with SCMS (Supply Chain Mgmt. System)

for ARV drug related issues, oversees COP planning related to HIV treatment activities, provides technical

leadership to MOH, USG and partners on treatment issues and supervises the Pediatric Treatment position

(to be recruited)

The ART site coordinator: Works to support all aspects of care and treatment scale-up at site level, this

involves frequent travel and close linkages with staff from partner organizations in the field including

supporting activities to improve quality of treatment scale-up (e.g. HIVQUAL). The position holder is

responsible to coordinate monthly USG Treatment Partner's Meeting; oversees all USG-funded renovation

and construction activities and supervises the ART site assistant

Funding for Treatment: Adult Treatment (HTXS): $0

PHE/Continuing activity : Activity ID # (from COP 07): 8632

Title of study: National ART Program Evaluation

Time and money summary: FY 2007 (200,000). Additional $300,000 were requested under plus-up in 2007

to cover study design changes that will allow more sites to be included in the sample, thus allowing every

province in the country to be represented with at least one large facility/urban site and one smaller/rural site.

This change makes programmatic sense but will increase costs - such as additional site managers, data

abstraction, patients follow up and travel costs. There are no funds being requested for FY 2008. Since the

protocol is in final stages of development, funds have not been spent so far.

The local co-investigators are: Dr Americo Assane Chief of Department of Medical Assistance,

Mozambican Ministry of Health; Dr. Florindo Mudender, Department of Medical Assistance, Mozambican

Ministry of Health. Dr Francisco Mbofana, National Institute of Health, Mozambican Ministry of Health.

The National ART evaluation project was modeled after similar projects currently ongoing in other countries

such as Rwanda and Kenya. Dr. Tedd Ellerbrock, Team Leader, HIV Care and Treatment, GAP,

recommended that this evaluation should also be carried out in Mozambique. The evaluation is unique in

that it involves population-based sampling of patients initiated on ART in country, intended to provide a

national "snapshot" of program quality. The project involves the evaluation of patient retention, weight, CD4

outcomes and viral load suppression at 6 and 12 months after ART initiation, using both a retrospective and

a prospective approach.

Stakeholders (MOH, USG, PEPFAR implementing partners) will participate in the planning and presenting

of the data at meetings and conferences, as well as disseminating information through routine channels

within the USG partners community and MOH organizational structure. Results will be submitted for

publication in an appropriate peer reviewed journal.

Funds allocated to this PHE will be used to support study staff needed to carry out this activity, data

collection related costs and laboratory supplies. Travel expenses to study sites and areas covered by the

study, as well as travel for international experts, are included.

The study protocol is in final stages of development, in collaboration with counterparts at the Ministry of

Health and should be finalized in October 2007. Protocol submission to local IRB and CDC ethical review

should occur in October 2007. The team of investigators should start field data collection in January 2008.

Funding for Treatment: Adult Treatment (HTXS): $215,869

Continuing activity: replacement narrative

This activity includes funding to partially support 3 staff positions within the CDC Mozambique that are

related to the treatment program namely:

ART site coordinator: Works to support all aspects of care and treatment scale-up at site level, this

involves frequent travel and close linkages with staff from partner organizations in the field including

supporting activities to improve quality of treatment scale-up (e.g. HIVQUAL). The position holder is

responsible to coordinate monthly USG Treatment Partner's Meeting; oversees all USG-funded renovation

and construction activities and supervises the ART site assistant

Senior treatment coordinator: Is responsible for USG-supported HIV treatment scale-up, chairs the USG

Interagency Treatment Working Group, is the main liaison with SCMS (Supply Chain Mgmt. System) for

ARV drug related issues, oversees COP planning related to HIV treatment activities, provides technical

leadership to MOH, USG and partners on treatment issues and supervises the Pediatric Treatment position

(to be recruited)

Treatment/lab/M&E officer :Works within the treatment team to support ART and lab related program

monitoring activities including: evaluating progress in program implementation, compiling, maintaining and

reporting on data records related to partner reports and proposal submissions; data compilation needed for

routine program monitoring, COP preparation and semi-annual and annual reports

Funding for Laboratory Infrastructure (HLAB): $240,942

Continuing activity: Funding in this activity will be used to pay partial salary and benefits packages for the

Sr. Treatment Coordinator. Additionally, the full salary and benefits package of a newly filled position - Sr.

Laboratory Specialist - will be paid by this activity's funding. Another approved, but yet-to-be-filled position

for the Treatment/Lab M&E Officer will also be partially funded by this activity. Each of these positions

provides significant support to the Laboratory Infrastructure program, one of the key PEPFAR programs.

FY07: Funding in this activity will be used to pay partial salary and benefits packages for two a Senior Care

and Treatment Specialist. Additionally, the full salary and benefits package of an approved, but yet-to-be-

filled position - Senior Laboratory Specialist - will be paid by this activity's funding. Finally, this activity will

pay a partial salary and benefits package of a proposed Treatment Logistics Specialist.

In the USG program, each of these positions provides significant support to the Laboratory Infrastructure

activities. Work involves coordinating with USG agencies, and implementing partners to assist the MOH to

ensure that laboratory reagent and equipment supplies are maintained to support HIV prevention, care and

treatment programs; training programs are developed to build human resource capacity in laboratory

management and practice and laboratory standards including quality assurance programs are implemented

and maintained.

Funding for Strategic Information (HVSI): $1,273,549

1) This activity provides funding for the salary and benefits packages for five positions - (1) M&E Advisor,

(2) Surveillance/Surveys Officer, (3) Sr. M&E Advisor (ADS), (4) Informatics Advisor and (5) Sr. SI

Specialist

(1) M&E Advisor. Under the guidance of the CDC Country Director and the Senior Technical Advisor for

Strategic Information (SI), the Monitoring and Evaluation (M&E) Advisor plays a critical role in strengthening

capacity and systems for M&E in the Government of Mozambique's Ministry of Health to measure the

national response to HIV/AIDS in Mozambique. As well, the M&E specialist works with USG partners at

both implementer and national levels to quantify progress towards targets set for PEPFAR.

The M&E Specialist advises the CDC Senior Technical Advisor for SI on all matters related to the

development and strengthening of routine HIV/AIDS related program reporting systems in Mozambique.

Specifically, the M&E Specialist works to strengthen systems and staff capacity at the MOH to collect,

manage, and use quality M&E data to inform programs and policies in the national response to HIV and

AIDS. The M&E Specialist also has responsibility for assisting the PEPFAR team in measuring the USG

contribution toward achieving the Emergency Plan targets through MOH reporting systems, and to adapt

PEPFAR-supported M&E and other Strategic Information tools to improve Emergency Plan programming

and service delivery.

(2) The Surveillance/Surveys Officer will oversee technical assistance provided for surveillance activities

and surveys which CDC supports, including sentinel surveillance, and national seroprevalence and

behavioral surveys. The Surveillance/Surveys Officer will provide technical assistance to the MOH to assist

with development of its surveillance program and its ability to conduct national surveys. Finally, the

surveillance/surveys officer will be the primary point of contact with multisectoral bodies such as the

Multisectoral Working Group, coordinating CDC participation in and support of data triangulation activities

with the NAC and UNAIDS.

(3) Sr. M&E Advisor. The main duties of the Sr. M&E Advisor are to plan, initiate, conduct, evaluate, and

coordinate complex HIV/AIDS applied empidemiologic research, surveillance, monitoring, evaluation,

epidemiological response, and program activities in Mozambique concerned with the reduction of HIV

transmission and mitigating the impact of HIV and AIDS. The Advisor assists and provides oversight in the

design and implementation of epidemiological studies, public health evaluation, and operations research

activities in Mozambique. The Advisor is also responsible for building capacity among USG partners in

developing and implementing PHE and operations research projects and protocols, ensuring ethical

standards are met, and tracking IRB and other ethical approval submissions.

(4) Informatics Advisor. Under the guidance of the CDC Country Director and the Senior Technical Advisor

for Strategic Information (SI), the Informatics Advisor plays a critical role in strengthening capacity and

systems for informatics in the Government of Mozambique's Ministry of Health to measure the national

response to HIV/AIDS in Mozambique. This position serves as a technical expert and consultant in the

areas of informatics, data analysis, software analysis, design, development, electronic communications

(including the Internet) and computer hardware support. Within the SI team, this advisor helps to establish

the direction and scope of the technical informatics activities of CDC/Mozambique and provides consultation

on the information resources and technologies needed to perform program activities. Finally, this advisor

provide technical leadership and oversight in directing, managing, planning, developing, coordinating and

evaluating public health informatics programs and activities in support of the Ministry of Health (MOH).

(5) Medical Epidemiologist (Sr. Strategic Information Coordinator) (USDH):

The incumbent is the team lead for the CDC SI team and is an integral member of all SI-related activities in

PEPFAR. She is responsible for the principle management and oversight of the collaborative program

design, implementation, monitoring and evaluation of primary prevention activities, analyzing program data

through statistical methods, and disseminating study results through scientific journals, periodic reports and

public presentations. The Sr. SI Coordinator also supports SI activities at the Ministry of Health and other

partner organizations. These activities include HIV-related surveillance and surveys, informatics, Public

Health Evaluations and M&E.

2) Support coordination and implementation of Behavioral Surveillance Survey+ $578,000

This will build on preliminary activities initiated with FY07 plus-up funding. Mozambique has not yet

implemented a round of Behavioral Surveillance. Formative work will be done in FY08 to identify key risk

groups (Phase 1) and to develop plans and protocol for BSS+ implementation (Phase 2). FY08 EP funds

will be used to provide financial and technical support for implementation of the Behavioral Surveillance

Survey; the BSS will monitor and assess baseline information in HIV-related knowledge, attitudes, and

behaviors among the at risk populations that are identified in the Phase 1 formative work. The survey also

includes a biomarker to estimate HIV prevalence for these groups. Funds will be used for technical

assistance needed to plan and implement Phase III, required commodities and lab supplies for BSS

implementation, contracting of local field teams for data collection and entry, and technical assistance for

data analysis and dissemination. Early funding (50% or $289,000) is requested for this activity as activities

will need to commence in April 08.

Funding for Strategic Information (HVSI): $0

COP07 activity number: 8632

Title: HIV Risk in Sex Workers and Drug-Using Populations in Maputo, Beira, and Nacala Porto,

Mozambique: An International Rapid Assessment, Response and Evaluation (I-RARE)

Time and money summary: Project implementation started in FY06 with the development and finalization of

study protocol and, coordination with the various stakeholders. Data collection, analysis and project

completion will occur in the first half of FY08. The total funding amount for the project is $450,000 (FY06:

$250,000 Plus Up Funds; FY07: $200,000); no additional funds will be requested for FY08.

Local Principal Investigators:

Dr. Alfredo MacArthur, Coordinator, National STI/HIV/AIDS Program, Ministry of Health, Mozambique

Pascoa Themba, Planning, Donor Coordination, Monitoring and Evaluation Coordinator, National AIDS

Council, Mozambique

Local Co-Investigators:

Joaquim Matavel, Mental Health Department, Ministry of Health (MOH), Mozambique

Dr Nuno Gaspar, Counseling and Testing Program Director, MOH, Mozambique

Project Description:

The I-RARE assessment and training package will provide Mozambican health professionals and

researchers with the skills to conduct qualitative assessments for vulnerable populations, including drug

users, commercial sex workers and Men having Sex with Men (MSM). These groups frequently engage in

illegal or socially stigmatised behaviours and have less access to HIV/AIDS services than the general

population.

Evaluation Question:

This evaluation intends to answer the following questions:

1) Can vulnerable and hidden high risk populations be reached in order to implement HIV prevention

interventions?

2) Can these populations be provided with risk reduction information and supplies to assist them in

preventing HIV, and can they be linked to counseling and testing, HIV/AIDS care and treatment services,

including diagnosis and treatment for opportunistic and sexually transmitted infections where needed?

3) Will these populations reduce their risk upon access to these interventions, including both drug-using and

sexual behaviors?

4) Will these populations utilize the services they are referred to?

Methodology:

I-Rare relies on systematic qualitative data collection and an analysis technique complemented by survey

information and direct observation. The methodology that will be used for the evaluation in Mozambique is

composed of five key elements: (1) Use and in-depth analysis of existing Mozambique date (e.g. from

surveillance and research previously conducted); (2) Oversight of the process by a professional

ethnographer; (3) Training of Mozambican staff using the I-RARE evaluation and training package (existing

materials will be translated to Portuguese and adapted to the Mozambican context); (4) Direct involvement

of community leaders and health care providers; and (5) Final evaluation conducted by an independent

evaluator

Data on key indicators including number reached, number referred, and sexual and drug using behavioral

risk indicators, as appropriate, will be collected. Qualitative interviews will be carried out with stakeholders

and members of the target population to evaluate acceptability and the need for adjustments.

Planned use of findings:

Results of the assessment will be used to strengthen community outreach to vulnerable groups and

systems for referrals to HIV prevention, care and treatment services. The major emphasis will be the

development of networks, linkages, and referral systems between outreach workers, NGO/CBOs and health

care service providers.

Status of the Study:

PEPFAR funding has supported the participation of Mozambican MoH staff at a first meeting conducted in

August/September 2005 in Tanzania, which has contributed to raising awareness within the MOH around

the importance of alcohol and drug use in relation to HIV transmission and risk behaviors. Furthermore, in

August 2006, a second MOH staff was invited to attend a National I-RARE dissemination and planning

meeting in South Africa, which provided the Ministry with concrete examples of activities, opportunities,

successes, and lessons learned within the African context.

A first pre-assessment and logistical coordination visit of CDC Atlanta technical experts with experience with

most at risk populations, particularly drug users and commercial sex workers, and implementing rapid

assessment projects was conducted in October/November 2006. During the visit, the team met with

Government institutions (MoH, National AIDS Council), USG, UN, NGOs, and other groups; conducted a

pre-assessment visit in Maputo city for preliminary observations and mapping of potential study areas; a

working group for IRARE was created and assessment protocols and tools were drafted.

During FY07 the following activities were conducted: (a) finalization of development of protocol and tools

and, submission to US review board and the Bioethics Committee in Mozambique. Approval from these

boards and administrative authorization from Mozambique's MoH for study implementation were obtained;

(b) two technical assistance visits from Atlanta; the first visit was conducted in May 2007, for orientation of

newly hired CDC STI / Vulnerable Populations Advisor, continuation of pre-assessment visits, in Nacala and

Beira cities, planing of training activities and data collection; (c) the second visit occurred in July/August

2007 for further planning, coordination and finalization of study related tools, development of plans for data

analyis and initiation of collaboration with the Faculty of Anthroplogy & Medicine/Univeristy of Edurado

Mondlane as well as a South African technical assistance (TA) provider; (d) identification and recruitment of

study teams (Team Managers, Team Coordinators, Field Team Members and, Counselors for HIV testing)

in Maputo, Beira and Nacala cities. Training of study teams is scheduled to take place early November 2007

and, data collection will start immediately after training. Data collection is expected to be completed after 3 -

Activity Narrative: 4 weeks, and data analysis will take approximately 4 months.

Lessons Learned:

Awareness and acceptance of the need for evaluation and development of HIV/AIDS interventions for

vulnerable and hard-to-reach populations was to start with comparatively low, in particular among high level

government policy makers. Above-mentioned events and advocacy by in-country USG staff and partners

has contributed towards creating an environment that is more open to assessing and addressing the needs

and starting to develop HIV/AIDS interventions that can effectively reach these groups.

Dissemination Plan:

After data collection and analysis, a workshop for dissemination of study results will be conducted in Maputo

city, chaired by the MOH and NAC, with TA provided by CDC, and participation from stakeholders involved

in the development of the study protocol (e.g. UNAIDS, PSI, Pathfinder, GetJobs, National Network to

Combat Drugs) and working with vulnerable populations in Mozambique. The study report will be widely

distributed in-country. In addition, abstracts and papers will be produced for submission for presentation for

international conferences and peer reviewed journals.

Planned FY08 activities:

The activities for FY08 include data collection, with ten Focus Group Discussions and 100 interviews at

each of the 3 study sites (Maputo, Beira and Nacala) being conducted; transcriptions of group discussions

and interviews; data entry and analysis; report writing and performance of a workshop for dissemination of

study results. Data from the rapid evaluation will be used to develop/improve materials and intervention

packages for work with and services for vulnerable populations in Mozambique. Funding for these

interventions has been included in COP08, for various international and national NGOs.

Budget justification for FY08 monies:

Completion of project will be done using funds from FY06/07; no additional funding is being requested for

FY08.

Salaries/fringe benefits: not applicable

Short-term contracts / consultancies for data collectors: $90,000

Short-term contracts / consultancies for data analysts: $50,000

Equipment: $15,000

Supplies: $10,000

Travel: $60,000

HIV & Syphilis Testing: $25,000

Transcriptions and translations: $50,000

Training: $70,000

Printing and reproduction: $25,000

Dissemination Workshop: $50,000

Other: $5,000

Total: $450,000

In line with MOH regulation no incentives will be provided to participants; however free HIV and syphilis

counseling and testing will be provided, as well as a referral system be set up to ensure free and rapid

assessment for eligibility and enrolment for ART for HIV-infected high-risk group members.

Funding for Health Systems Strengthening (OHSS): $280,812

Continuing Activities from 2007: This activity continues support for salary and benefits for the Senior

Training Specialist and Training Advisor. The Training Advisor provides technical assistance directly to the

Ministry of Health's Training Department on all MOH specific projects such as the development of the

Training Information System, development of the yearly plan and budget, assisting implementing partners in

their work with the MOH, co-facilitating trainings, and advising CDC technical staff on training and human

resource priorities for the MOH. The Senior Training Specialist supervises the two CDC-based training

advisors and works directly with PEPFAR funded partners and technical staff at CDC and USAID around

training and Human Capacity Development planning and implementation. Senior Training Specialist acts as

the lead training/HCD staff person and in that capacity leads the development of the COP and all other

strategic planning.

Funding for Management and Operations (HVMS): $554,743

The CDC office currently has forty-three (43) positions under various mechanisms - including six (6) direct

hires, thirteen (23) locally employed staff, one (1) Eligible Family Member (EFM) and thirteen (13)

contracted staff (COMFORCE, PSC). Twenty-nine (29) positions are currently filled, six (6) are in process

and eight (8) positions are currently vacant, but will be filled in the near future. Three of these eight are

previously filled positions. Recruiting and hiring in Mozambique has proven to be difficult on many fronts

including lack of available hiring mechanisms (Comforce is no longer available for overseas hires), dire/visa

issues with the local government and severe shortage of local human resources. Even with tremendous

challenges, CDC has been able to fill many of the vacant positions and is on line to fill the outstanding

vacancies during this next year.

In addition to the previously approved positions, CDC Mozambique is proposing 20 technical and

administrative positions that will manage the significant increase in activities for 2008 and beyond. They are

discussed in the Staffing Matrix as well the individual program activities that will fund these positions.

CDC received approval in the 2006 COP to expand the office to the adjacent space in our existing building.

We are now occupying the new offices. Most of the costs included in the M&S budget cover expenses

related to supporting the CDC staff and office expenses. Some technical staff salaries are included in the

M&S budget per COP Guidance.

This activity contains funding for various administrative activities:

- Atlanta paid - Technical Assistance Travel for non-GAP staff ($75,000)

- Contractual staff salaries and benefits (PSC, COMFORCE) - Sr. Prevention Coordinator (existing),

Technical PHA (proposed) and Behavioral Scientist/Medical Officer (proposed). Note that we have

requested early funding for this amount to assure funding availability in the early months of 2008.

- Shipment of things by Atlanta held Funds ($50,000)

Technical Public Health Advisor (USDH) - This position will provide technical support on the Cooperative

Agreements supporting PEPFAR. This will include monitoring and oversight of the various agreements with

the Ministry of Health, universities, and NGOs, including activities and budget. This position will also

provide support on other CDC-wide processes involving a wide variety of administrative matters.

Behavioral Scientist/Medical Officer/Epidemiologist (USDH) - This position serves as the GAP Technical

Advisor, HIV Prevention/ Behavioral Science for CDC GAP and leads and directs an interdisciplinary team

which manages programmatic intervention strategies, studies of the behavioral aspects of HIV prevention,

and other qualitative research involving all program areas. The position helps develop program strategies;

supervises and monitors program implementation and evaluations; identifies program priorities; participates

in the design and implementation of HIV/AIDS behavioral interventions; collaborates with scientists at other

governmental and nongovernmental agencies or organizations to identify issues relevant to the

implementation of behavioral research; assists in providing technology transfer of research findings to

community based and other organizations; and prepares program announcements as needed.

Subpartners Total: $800,000
Not Identified: $800,000