Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3529
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: $5,095,078

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $135,748

Continuing activity: Replacement narrative

This activity will partially fund the salary and benefits package for the CDC PMTCT/CT Study Advisor who

will work with the Ministry of Health PMTCT staff and stakeholders involved on the finalization of the

assessment of clinical staging performed by PMTCT personnel with comparison to CD4 & TLC (total

lymphocyte count) to determine eligibility for antiretroviral therapy, and dissemination of findings through

presentation of findings to MOH and stakeholders in-country, reproduction and dissemination of the final

report. Please see the Public Health Evaluation Background sheet for more information.

The remainder of this activity funding is requested to support the USG PMTCT program in the following

areas:

1) Travel expenditures for the CDC PMTCT staff facilitating regional and provincial PMTCT trainings, and

participating in PMTCT site supervision and quality assurance, in particular to 2008 focus provinces; CDC

technical staff visits to the PMTCT reference center and satellite units in Nampula Province; and

participation in PMTCT program evaluation activities.

2) Participation of MOH and USG staff in international and/or regional continuing education events relevant

to PMTCT program policy development and management, including staff visits to areas with robust district-

level support activities. Participants to be selected in discussion with the Ministry of Health (MoH)

Community Health, Reproductive Health and PMTCT programs and National AIDS Council (NAC).

3) Exchange visits for MOH and USG PMTCT staff (to be selected in discussion with MoH PMTCT program

and NAC) to countries within the African region to learn from experiences in integration of PMTCT services,

infant and child follow-up, integration of Counseling and Testing, and male partner involvement.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $12,343

This activity contributes to salary and benefits for the CDC HIV Prevention Specialist, who oversees,

coordinates MOH and partners, provides technical inputs, and monitors A/B activities targeting health

workers at MOH health facilities, and students at MOH training institutes.

Activities include: (a) Development of new A/B informational/educational materials for health workers and

students; (b) technical assistance in applying health worker quantitative and qualitative assessment findings

to the task of BCC intervention design in the areas of A/B; and (c) development and piloting behavioral and

educational interventions focused on issues of abstinence and faithfulness at MOH health facilities and

training institutes.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $59,420

This activity contributes to a portion of the salary and benefits package for two CDC technical staff:

(1) The CDC HIV Prevention Specialist, who oversees, coordinates MOH and partners, provides technical

inputs, and monitors C&OP activities targeting health workers at MOH health facilities, and students at MOH

training institutes.

Activities include: (a) Development of new C&OP informational/educational materials for health workers and

students; (b) technical assistance in applying health worker quantitative and qualitative assessment findings

to the task of BCC intervention design in the areas of C&OP; and (c) development and piloting behavioral

and educational interventions focused on issues of condom use and other prevention activities at MOH

health facilities and training institutes.

(2) The STI / Vulnerable Populations Technical Advisor, who oversees, coordinates MOH and other

partners, provides technical inputs, and monitors C&OP activities targeting Most-At-Risk Populations

(MARPS).

Activities include the development or adaptation of a comprehensive intervention package for MARPS,

including C&OP materials and interventions, which are made available to implementing partners working

with MARPS in Mozambique. The Advisor will also lead organization and facilitation of training for staff from

MOH and partner agencies working with MARPS.

In addition some funding under this activity will support in-country travel for both staff for supervision and

training activities, as well as their participation in regional/international continuing education events or study

tours to other projects.

Funding for Care: Adult Care and Support (HBHC): $0

Title: Integration of Sexually Transmitted Infection (STI) Prevention, Diagnosis, and Treatment into Routine

HIV Outpatient Clinical Care in Mozambique

Time and money: Project implementation started in FY06 with the development of study protocol and

coordination with the various stakeholders; in FY07 the study protocol was finalized, submitted for

appropriate approvals, and data and sample collection started; in FY08 data and sample collection will

continue and it is expected to complete the activity by June 2008. FY08 is therefore year 3 of this activity.

The funding provided for this activity in FY06/07 ($250,000) will suffice for completion of the activity and no

additional funds will be requested for FY08.

Local Principal Investigators:

Felisbela Gaspar - STI Program Coordinator, Ministry of Health, Maputo, Mozambique

Rui Bastos - Head of Department of Dermatology and Venereology, Maputo Central Hospital, Maputo,

Mozambique

Elena Folgosa - Head of Department of Microbiology and Parasitology, Medical Faculty, Eduardo Mondlane

University, Maputo, Mozambique

Project Description:

This is a proposal to reduce HIV and STI transmission through integration of STI prevention, diagnosis,

treatment into routine HIV outpatient clinical care at anti-retroviral treatment sites in Mozambique. The

project will assess prevalence of STIs in HIV-infected individuals (syphilis, genital HSV, chancroid,

gonorrhea, trichomonas, and chlamydia for all, genital candidiasis and BV for women) upon entry into HIV

clinical care. Findings will be used to determine if STI syndromic guidelines should be modified for HIV care

settings. Through review of practices and standards of care, investigators will identify other opportunities

for improvement of STI diagnosis and care in this population.

Evaluation Question:

To reduce HIV and STI transmission through the integration of STI prevention, diagnosis, treatment, and

partner services into routine HIV outpatient clinical care.

Specifically to,

1. Assess training needs for HIV outpatient clinical providers in the use of STI syndromic algorithms tailored

to HIV-positive individuals and on the critical importance of early identification of these STIs.

2. Determine patterns of disease in symptomatic HIV-infected individuals for STIs upon entry into HIV

clinical care (syphilis, genital HSV, chancroid, gonorrhea, trichomonas, and chlamydia for all, genital

candidiasis and BV for women)

3. Link STI laboratory data with clinical and behavioral data to understand (1) the burden of STI in HIV-

infected individuals (prevalent infection), (2) the proportion of STI in HIV-infected individuals that is

symptomatic vs. asymptomatic, and (3) provider ability to identify GUD, and vaginal and urethral discharge

in HIV-infected individuals.

4. Determine possible barriers to partner management of HIV positive patients with STIs.

5. Evaluate the need for HIV-infected individuals receiving ongoing HIV care to be periodically assessed for

incident STI.

Study Design and Methodology:

This is a multi-center cross-sectional survey of the prevalence of STIs among individuals utilizing two

selected ART treatment sites in Mozambique. All new patients being registered at the two Day Hospitals will

be invited to participate in the assessment. One ART site (Mavalane General Hospital) will be located in the

city of Maputo and the other will be in the province of Gaza (Xai-Xai Provincial Hospital). The country of

Mozambique has a population of 20 million people, of whom an estimated 16.2 percent are thought to be

HIV positive (1.8 million). We used estimates of the prevalence of the least common STI of interest

(gonorrhea, approximately 4.2%) from a previous study of the prevalence of STIs among females, ages 14

- 49 years, using family planning services. We estimate a need to enroll a total of 500 individuals, 95% CI

(250 from each site). This estimate allows for a 10 percent margin for exclusions due to incomplete surveys

and lost or not quantifiable specimens. We expect that it will take approximately 3 to 4 months to meet

target enrollment at each of the sites, an additional 2 months for laboratory testing, and 4 months for data

analysis report writing.

Planned Use of Findings:

Results from this evaluation will be used to provide the Mozambique Ministry of Health (MOH) with data that

can be used to:

1. Adapt existing national syndromic STI management approaches used for HIV-infected patients;

2. Develop screening guidelines for asymptomatic STIs among HIV-infected patients;

3. Identify and enhance partner management services of partners of HIV-positive patients, by assessing STI

diagnosis, and treatment results in improving HIV testing among partners;

4. Identify gaps in STI management-training for HIV care providers.

Status of the Study:

A study working group has been formed to discuss the various aspects of integrating STI diagnosis,

prevention, and treatment into an HIV care setting. The working group consists of individuals from the MOH

ART treatment and STI programs, clinical and National Health Institute laboratories, Maputo Central

Hospital Senior Clinical Advisors and CDC prevention, treatment and M&E staff.

A study protocol was developed, submitted for appropriate ethical reviews in the US and the Bioethics

Committee in Mozambique. Both boards have approved the protocol and, the Mozambique Ministry of

Health also provided administrative authorization for study implementation.

Needs assessment visits were conducted to clinical and laboratory sites at Mavalane and Xai-Xai study

sites. During the visits, orientation meetings were conducted with local health authorities and study site staff

to explain project objectives and methodologies, and to coordinate logistics of implementation.

A technical assistance team from the CDC Atlanta STI division is assisting the country with training for study

staff conducted in September 2007, as well as during the first weeks of data and sample collection in

September/October 2007. Senior staff from the MoH, the Faculty of Medicine, and the National Institute of

Health has facilitated the training and are now supervising study implementation.

Activity Narrative:

Lessons Learned:

It has been valuable to have commitment and involvement from high level MOH staff to appropriately

develop, share and present draft assessment protocol and tools. While participation from the various

agencies may make this process lengthy, it enhances MOH ownership and contributes to highly relevant

and appropriate tools being developed.

In addition, discussions with key MOH stakeholders and staff in preparation for the assessment protocol

have already assisted in raising awareness about the importance of systematic and improved STI diagnosis

and treatment for HIV-positive patients as well as helped to identify major errors in reporting of STI data at

treatment sites that will be worked upon while further preparations for the assessment are ongoing.

Dissemination Plan:

After data collection and analysis, expected to be completed by May 2008, a workshop for dissemination of

study results will be conducted in Maputo city, chaired by the MoH, Medical Faculty, National Institute of

Health investigators, with support from CDC, and participation of stakeholders involved in implementation of

HIV/STI programs in Mozambique. The study report will be widely distributed in country. Additionally,

abstracts and papers will be produced for submission for presentation at regional/international conferences

and peer reviewed journals.

Planned FY08 activities:

The activities for FY08 include the completion of data and sample collection, completion of laboratory tests

including quality control conducted in the US, data entry and analysis, report writing and performance of the

workshop for dissemination of study results.

Budget justification for FY08 monies:

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

FY08. A breakdown of the initial budget is provided below. Some of the expenditures will already have

occurred as supplies have been procured, training has been conducted, and the study is currently ongoing.

Travel & per diem for MOH supervisors: $35,000

Laboratory supplies & equipment: $125,000

Transport of equipment & supplies: $10,000

Training of personnel at study sites: $10,000

Data analysis and feedback meeting: $50,000

Printing and dissemination of the report: $20,000

Funding for Care: Adult Care and Support (HBHC): $219,920

This activity sheet describes funding for external support to the Mozambique Ministry of Health (MOH) for

three components divided into Home-Based Care (HBC), Sexually Transmitted Infections (STI)/HIV, and

Opportunistic Infections (OIs) prevention and control.

Home Based Care (HBC): This provides a small amount of flexible external funding for back-up support to

the Ministry of Social Action and the Ministry of Health for possible needs that may arise related to materials

development, consultancies for technical support and exchange visits, regional meetings or conferences.

Additionally, these funds will support the salary benefits for the Community Care assistant who works

closely with the Ministry of Health and Ministry of Women ans Social Action as well as the USG partners in

developing community based HIV care and support programs.

Sexually Transmitted Infections (STI)/HIV: This activity contributes to salary and benefits for the CDC STI /

Vulnerable Populations Technical Advisor, who oversees, coordinates MOH and other partners, provides

technical inputs, and monitors STI/HIV activities targeting the general population as well as Most-At-Risk

Populations (MARPS).

Activities include support to: (a) Development of interventions, and revision and adaptation of STI

guidelines, training materials and job aids for integration of STI screening and treatment for HIV-infected

patients attending ART and PMTCT service settings; (b) Coordination of training, and procurement and

distribution of equipment to improve STI etiologic diagnosis at central level and provincial laboratories at

major hospital ART sites; and (c) Design and piloting of interventions to increase and improve HIV and STI

screening and services for MARPS.

In addition some funding under this activity will support in-country travel for supervision and training

activities, as well as participation in regional/international continuing education events or study tours to other

projects.

Opportunistic Infections (OIs) prevention and control: This activity contributes to the salary and benefits for

the CDC OI Technical Advisor who oversees and coordinates OI related activities with the MOH and

implementing partners. It also provides a small amount of flexible external funding for back-up support to

the MOH related to OI training and M&E activities.

Finally, included are the partial salary and benefits of the Care M&E officer who works within the CDC Care

team to support palliative care (home based and clinic based) 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.

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 is linked to activity sheets 8587, 8570 and 8631 in relation to HIV-STI integration.

Funding under this activity will support the following HIV-STI integration activities:

(a) provision of technical assistance for the development/review of routine monitoring and data collection for

HIV and STI patients at outpatient consultations and HIV/AIDS treatment service sites;

(b) reproduction and distribution of revised HIV/STI registers, data collection tools and job aids; and

(c) finalization of the assessment of integration of STI diagnosis, treatment and improved partner services

into routine HIV outpatient clinical care.

In addition this activity will fund the following HBC program support activities:

(a) travel for Home-Based Care (HBC) Technical Advisor and FSN;

(b) participation in exchange visits and continuing education events for professional growth for the

multisectoral team working on the development of Integrated Care and Support systems, both for MOH

(Ministry of Health) and MMAS (Ministry of Social Welfare) staff.

Funding for Care: TB/HIV (HVTB): $228,772

This activity will support continuation of technical assistance provided to the Ministry of health during FY07

for implemention of TB and HIV colaborative activities. Funds will be used to update national guidelines

and/or develop new ones in accordance with international standards for TB/HIV, X-MDR-TB management

and infection control. Further, the existing policy documents and guidelines will be printed and distributed

within the country. The new reporting system for drug resisnta TB will be implemented to all provinces and

to strengthen coordination between NTP and partners, coordination meeting will take place in all 3 regions

and at the national level.

Additionally the requested funds will be used to support partially or in full, 4 CDC staff positions involved in

the TB/HIV program implementation and monitoring as follows:

Pediatric treatment specialist, who serves as the technical officer responsible for planning, organizing and

monitoring pediatric HIV care and treatment projects in order to scale up and improve the provision of HIV

care and treatment for children. In this capacity, provides technical guidance for all CDC-Mozambique

supported pediatric care and treatment activities in the context of both the Ministry of Health (MOH) and

overall CDC-Mozambique strategic programs that aim to expand and improve prevention, follow-up, care

and Antiretroviral treatment (ART) services for children infected with HIV.

Care M&E officer: :Works within the CDC Care team to support palliative care (home based and clinic

based) 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

OI Advisor: Works within the CDC care team and serves as the lead technical officer with the overall

responsibility for planning, organizing and monitoring HIV related Opportunistic Infections (OI) projects in

order to scale up and improve the management of OI's. In this capacity provides technical guidance for all

CDC-Mozambique supported OI management activities in the context of MOH and the Emergency Plan

overall strategic programs that aim to expand and improve prevention, follow-up and care services for

PLWHA.

TB/HIV specialist: serves as the lead technical officer for CDC with the overall responsibility for planning,

organizing and monitoring TB/HIV activities. The advisor provides technical guidance to the MOH, CDC-

Mozambique, the Emergency Plan interagency group and implementing partners on TB/HIV collaborative

activities.

Funding for Prevention: HIV Testing and Counseling (HVCT): $395,748

Continuing activity: Since the beginning of Counseling and Testing (CT) service delivery in 2001/2, the USG

has supported the establishment and expansion of CT services. The national CT expansion strategy has

undergone some major changes since early 2005. CDC has been providing Technical Assistance (TA) to

scale up Provider Initiated Counseling and Testing (PICT) in clinical settings, and promote, pilot and expand

the "Counseling and Testing in Health" (CTH) approach.

The proposed funds will contribute to and support the following activities:

(a) Reproduction of CT materials ($25,000) - Printing and disseminating revised guidelines and training

materials for CT in clinical settings, CT in Health, and community-based CT.

(b) Support for a CTH external evaluation and comprehensive CT program evaluation ($200,000).

(c) CT M&E contracts and activities ($75,000) - support the transition from the current CT database to a

new system and new procedures of data collection.

(d) Participation of Ministry of Health, National AIDS Council, and USG CT staff in conferences and study

tours and staff in-country travel ($70,000).

(e) Partially fund the salary and benefits package for the CT and PMTCT Study Advisor who will be the lead

technical staff to implement and complete the PHE entitled ‘The validation, acceptability, and feasibility of

oral fluid based rapid antibody testing in Mozambique'.

FY07: Plus-up:This activity will support the translation, adaptation and piloting of guidelines and training

materials for counseling and testing (CT) of children in Mozambique. Funding will go towards provision of

technical assistance to the Ministry of Health (MOH) CT staff for adaptation of the materials, facilitation of

first pilot trainings and implementation at first selected sites. Special attention will be paid to providing

guidance for CT for children in a variety of settings such as at community level as part of home-to-home CT

services and in clinical settings such as pediatric consultations and childrens' wards. Health care workers

and counselors will be trained to provide counseling to parents and caretakers as well as on ways to

counsel, disclose HIV status and support older children undergoing HIV-testing.

Original COP: This activity is linked to 8597, 8608, and 8568 activity sheets.

Please also see linkage to the CDC's Public Health Evaluation of oral fluid-based HIV testing.

Funds for FY07 are requested to support a number of key activities required to ensure CT program staff at

CDC and in the Ministry of Health's (MoH) are sharing and learning lessons from program implementation.

Funding requested will cover:

1) Travel expenditures for the CDC CT Technical Advisor to participate in regional and provincial

coordination meetings and trainings, for the CDC M&E Advisor to participate in regional and provincial CT

data management and supervision visits, and for the CDC Senior Prevention Advisor to participate in quality

assurance and supervision visits; in particular to 2007 focus provinces Sofala and Zambezia.

2) Travel and registration fees for international and/or regional continuing education events relevant to CT

program policy development and management for three people, to be selected in discussion with the MoH

CT program and National AIDS Council (NAC).

3) Exchange visits (around 5 CT staff to be selected in discussion with MoH CT program and NAC) to

countries within the African region to learn from experiences in integration of CT in clinical settings,

implementation of community-based CT (e.g. Kenya, Uganda) and integration of lay counselors into the

public health care system (e.g. Zimbabwe).

4) Finalization of the evaluation of oral fluid HIV testing in Mozambique and dissemination of findings

through presentation of findings to MOH and stakeholders in-country, reproduction and dissemination of the

final report. See the Public Health Evaluation sheet for additional information.

Funding for Treatment: ARV Drugs (HTXD): $6,940

Funding in this activity supports the partial salaries and benefits for the ART site support assistants (2); who

work within the treatment team to Support care and treatment scale-up at site level--this involves frequent

travel and close linkages with staff from partner organizations in the field as well as support activities to

improve quality of treatment scale-up (e.g. HIVQUAL)

Funding for Treatment: Adult Treatment (HTXS): $357,020

Continuing Activity: Replacement Narrative.

Funding under this activity will be used to support CDC Mozambique treatment related activities that

include: Costs for travel, accommodation and expenses for supervision and monitoring of partner supported

ART programs; participation in regional and international HIV related meetings; and support in-service

training of health staff in Zambezia as part of the provincial focus support to that province.

An additional component of this activity is funding for 5 staff positions that contribute part of their time in

supporting the treatment program as follows:

HIV Prevention Specialist, working with ART and HIV/AIDS service partners to support and guide the

development, implementation and monitoring of Prevention with Positives (PwP) activities at six PwP

demonstration sites as well as facilitating PwP training of trainers for USG-funded ART partners and

national NGOs/CBOs supporting PLWHA groups.

Pediatric treatment specialist, who serves as the technical officer responsible for planning, organizing and

monitoring pediatric HIV care and treatment projects in order to scale up and improve the provision of HIV

care and treatment for children. In this capacity, provides technical guidance for all CDC-Mozambique

supported pediatric care and treatment activities in the context of both the Ministry of Health (MOH) and

overall CDC-Mozambique strategic programs that aim to expand and improve prevention, follow-up, care

and Antiretroviral treatment (ART) services for children infected with HIV.

Laboratory technical assistant who provides oversight for a range of broad laboratory related programs and

activities that are carried out by CDC as well as all partners implementing HIV care and treatment. The

basic function of this position is to provide expert advice and guidance for helping to develop and expand

adequate laboratory infrastructure and for establishing and implementing sound laboratory practices.

ART site support assistants (2); who work within the treatment team to Support care and treatment scale-up

at site level--this involves frequent travel and close linkages with staff from partner organizations in the field

as well as support activities to improve quality of treatment scale-up (e.g. HIVQUAL)

ETR manager a new position proposed this year to support implementation and scale of the Electronic TB

register by the MOH. The position involves working closely with the MOH data manger on coordinating

training, supervising sites implementing the program as well responding to questions and problems and

linking to CDC regional and HQ for technical support. This position will also interface with the treatment

program with respect to monitoring HIV/TB indicators relevant to both programs.

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

PHE/Continuing activity - Activity ID # (from COP 07): 8639

Title of study: Evaluation of cost and cost-effectiveness of HIV treatment to support resource planning

Time and money summary: FY 2007 (292,000). There are no funds being requested for FY 2008. The initial

activities will start in September 2007, with an initial planning trip from the Atlanta based team to

Mozambique.

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.

This activity proposes a public health evaluation to measure the costs of comprehensive HIV treatment in a

sample of PEPFAR-supported facilities, and to evaluate the cost-effectiveness of these programs. This

project builds upon and complements concurrent evaluations to assess treatment program outcomes and

cost-effectiveness and contributes to a national ART program evaluation. The evaluation will facilitate USG

and partner program planning and resource allocation by assessing the potential reach of ART programs

given available financial resources, informing selection of optimal program models, and locating areas

where potential efficiency gains could free-up resources to expand service provision.

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.

The first planning/assessment trip will take place in September 2007. Study protocol is in development 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 Laboratory Infrastructure (HLAB): $49,143

This activity will partially fund the salary and benefits package for three approved but yet to be filled

positions which are: the ART Site Assistant, the Art Site Support Assistant, and the Lab Technical Assistant.

Laboratory Technical Assistant - This position serves as the Laboratory Technical Assistant within the CDC

-GAP laboratory section. The employee will have oversight of broad laboratory related programs and

activities that are carried out by CDC as well as all implementing partners in the area of laboratory support

to the national laboratory network for monitoring patients in HIV care or on antiretroviral therapy.

ART Site (Support) Assistant (2) - To provide technical guidance and support to CDC partners as ART

services expand, such as ensuring quality of care, tracking patients, ensuring medication, etc.

Funding for Strategic Information (HVSI): $510,110

This is a new activity (local funds) but consists of many sub-activities, many of which are existing sub-

activities under an existing/previous mechanism/activity (CDC HQ funding)

1) CDC - GHAI-Local-Salary Distribution

2) Monitoring of early warning indicators by MOH

3) Host regional IRB/ethics training workshop

4) Support 3 - 5 proposed Operations Research-related projects stemming from the CY2007 OR Workshop

5) Support TA to develop a STI database

6) Technical assistance for sentinel surveillance

1) CDC - GHAI-Local-Salary Distribution $150,110. Funding in this activity provides full salary and benefits

packages for three positions - (1) a SI Reporting Specialist (existing) and (2) two Provincial M&E Officers

(proposed).

(1) SI Reporting Specialist (existing) The SI Reporting Specialist plays a critical role to review and

disseminate SI related developments and requests. If needed, the specialist provides follow-up or assist in

completion of the SI-related task. Thie position is also responsible for assisting in coordinating, gathering,

inputting, storing, and analysis of PEPFAR COP targets, SAPR and APR results, as well as providing

interpretation of OGAC guidance.

(2) Two Provincial M&E Officers (proposed)

Mozambique's provincial-level HIV programs suffer from lack of human resources to implement the M&E

activities necessary to track the rapid geographic expansion of ART programs in FY07. Two Provincial M&E

Officers will be hired to work in Zambezia and Sofala to provide institutional support to the Provinical HIV

program at the Provinical Health Departments (DPS). These officers will develop data quality assurance

programs and supervision at the district and provincial level, monitoring HIV program components at the

district and provincial level, tabulate and analyse program data for routine and ad hoc reports, and providing

decision support for DPS planners. The positions will report to the CDC SI team to help ensure program

consistency and quality across focus provinces.

2) Support implementation of drug resistance monitoring by MOH $20,000

Monitoring and controlling the emergence of drug resistance in Mozambique is important in order to be able

to ensure the quality of the ART program and to rationally plan national treatment regimens. MOH has

assigned responsibility for ART drug resistance monitoring to the ART monitoring committee of the MOH.

The committee, in consultation with CDC and WHO has developed a plan to monitor the emergence of drug

resistance. The plan calls for a) monitoring of routinely-collected Early Warning Indicators (EWI) from

treatment sites, b) monitoring of treatment failure, adherence and drug resistance in cohorts at a sample of

treatment sites, and c) threshold surveillance of transmitted drug resistance during sentinel surveillance.

This activity will allow CDC to provide technical assistance to the ART committee and ART resistance

coordinator to help conduct these activities. Additionally, funds may be used to pay for data entry

personnel, development of data collection and data entry tools. This activity is related to activity 12267.08.

3) Host regional IRB/ethics training workshop for regional CDC/GAP Associate Directors for Science, USG

program/ technical staff members, and in-country IRB/bioethics committee members $75,000

This activity will entail bringing together experts from the US, neighboring countries and Brazil to share

expertise with regional ADSs. The goal of this workshop is to provide participants with training in evaluating

protocols, seeking IRB approval following CDC regulations and ethical standards and to promote exposure

to experienced staff that can guide local participants in establishing/strengthening ethical review procedures

in country.

4) Support 3 - 5 proposed Operations Research-related projects stemming from the CY2007 OR Workshop

$75,000

As a follow up activity from the FY07 funded OR workshop, funds will be used to provide 5 provincial

program staff and their mentors the ability to carry out small operational research projects. Each of those

five will have had its draft protocol produced during the workshop, and the FY 08 money will allow them to

conduct small scale primary data collection, perform secondary data analyses using program data and will

facilitate contact between the mentors, most of whom are based in Maputo, and the workshop participants

by funding travel to the field. Note that CDC will ensure that all ethical considerations are included in the

proposals and that any ethical approvals are acquired by local and Atlanta-based IRBs as appropriate.

5) Support TA to develop a STI database $100,000

During FY 2007 CDC has provided technical assistance to the STI program at MOH to develop and pilot

updated case notification forms for syndromic reporting of STIs. The updated notification system will allow

tracking of STIs in HIV-positive individuals in care and treatment. The STI program database was originally

designed to match the previous version of the forms and must be updated to allow data to be entered from

the new forms. During 2008 CDC will provide additional technical assistance to the STI program to ensure

introduction of STI reporting in HIV care and treatment facilities and update the STI program database to

reflect the changes to the layout of the forms. Early funding for the entire amount of $100,000 is being

requested in order to allow database development to begin in early 2008 soon after completion of the pilot.

6) Technical assistance for sentinel surveillance $90,000

This activity is associated with Mozambique's SI five year strategy to technically and financially support

surveillance to monitor HIV/AIDS-related illnesses, understand the behaviors that influence transmission,

improve access to and use of care and treatment services, strengthen the effectiveness of program

activities, and ensure a supportive environment for USG efforts.

The Ministry of Health, in coordination with donor and technical assistant partners, began implementing

routine HIV/AIDS sentinel surveillance among pregnant women in 1998 in 10 sites. In 2007 during the latest

round, sentinel surveillance was conducted at 36 sites throughout the country and dry blood spot (DBS)

technology, BED incidence assays, and threshold ARV resistance monitoring were introduced. Data from

the sentinel surveillance round are used to describe the current burden of disease among pregnant women

and to produce estimates of the burden and impact of HIV/AIDS in the country and to monitor trends in

disease over time. Sentinel surveillance data are the cornerstone of allocating resources in the country as

well and are currently the national source for HIV prevalence estimates. For example, data are used to

determine priority areas for opening new treatment sites and focusing prevention efforts.

Activity Narrative:

Since 2001, CDC has provided complete financial and technical support for sentinel surveillance activities in

Mozambique. In 2008, funds will be used to provide technical assistance to the MOH to prepare trainings

and conduct supervision, and assist with organization of logistics such as shipping of specimens and study

instruments from the sites to the MOH, to prepare study databases and contract data entry personnel, and

to assist with data analysis. This activity is related to activities 12267.08 and 15916.08.

Funding for Strategic Information (HVSI): $1,350,000

August 2008 Reprogramming: Increase funding by $617,542.

Support TA, fieldwork, supervision and logistics for an AIDS indicator survey with HIV testing.

The only source of nationally-representative HIV indicator data in Mozambique to date was collected during

the 2003 DHS. In order to estimate the number of infections averted, a second HIV indicator data point is

required by mid 2009. In addition, as of yet no nationally-representative serosurvey has been performed in

Mozambique. While both of these needs could be met by performing another DHS, due to the recent

population census, upcoming elections, and competing survey priorities, the National Statistics Institute

(INE) has indicated that they will not conduct a DHS until at least 2010.

The National Institute of Health (INS) of the MOH has indicated that they wish to conduct National Survey

on HIV prevalence, risk behaviors, and information about HIV/AIDS in 2008. Sample design will cover

approximately 6,000 households and will include HIV testing of approximately 18,000 individuals including

children. The sample design will allow estimation of prevalence by province, sex, and age group. The

survey will include a social mobilization component prior to fieldwork to ensure adequate response rates.

This activity will fund a partner to provide a technical assistance, social mobilization, fieldwork, supervision,

and survey logistics. Procurement of sample collection and processing equipment and supplies will be

performed by a different partner and is described in a related activity. The budget will not fully fund the

survey and it is expected that other donors will also contribute to the full cost of the survey. This activity is

related to activity 15916.08.

Funding for Health Systems Strengthening (OHSS): $88,037

This activity will support the strengthening of the only existing MPH program in Mozambique located in the

faculty of Medicine at Eduardo Mondlane University. There were discussion two years ago regarding this

idea and, at the time, there wasn't sufficient leadership to move forward. Recently a new director for the

MPH program and a new rector for the university have been appointed. Also Emory University, who is

providing scholarship to students in the MPH program, has asked for our support in strengthening the

existing program. Funds would be used to support technical assistance and development of a proposal for

strengthening the program.

Funding for Management and Operations (HVMS): $1,681,877

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 the following administrative costs:

- Salary Costs - ($168,161) Prevention M&E Officers I & II (proposed), Outreach and Information Specialist

(proposed), Contract Specialist I (proposed), Contract Specialist II (proposed). See below for position

descriptions for these proposed positions.

- New phone system and peripherals - $20,000

- Post Paid Travel - $462,065

- Residential Electricity (X DH and X PSC) - $114,000

- Residential Water (XDH and X PSC) - $34,200

- Telecommuting (Direct Hires) - $19,380

- Local Guard Service - $105,600

- CDC Staff Training - $50,000

- Computer Equipment - $40,000

- Administrative Training (including course expenses and travel) - $100,000

- Housing Upgrades - $356,000

- Office Rents - $212,471

Prevention M&E Officers (FSN) - This position will advise the USG Prevention Team on all matters related

to the development and strengthening of routine HIV/AIDS related prevention program reporting systems in

Mozambique. Specifically, the M&E Officer will strengthen systems and staff capacity at the MOH to collect,

manage, and use quality M&E data to inform program and policy in the national response to HIV and AIDS.

The M&E specialist will also have 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 (SI) tools to improve Emergency Plan

programming and service delivery.

Outreach and Information Specialist (EFM) - The Outreach and Information Specialist works closely with

the Country Director, technical programs, U.S. Embassy PAO, and other USG partners to help lead

PEPFAR Mozambique's information and public outreach efforts. The Information Specialist serves as the

primary point of contact and liaison for CDC with the Embassy's Public Affairs Office for local and

international media and is responsible for collecting, analyzing, investigating, managing and distributing

composite information about the CDC program in Mozambique. The Outreach and Information Specialist

ensures that all outreach and responses to the Congress, the State Department, partners and customers

are high quality and accurately reflect the latest CDC vision and accomplishments as well as CDC

guidance. He/she is the first point of contact for any information inquiry or letter request. He/she prepares

special and routine reports; develops and packages special briefings and responses; leads outreach and

public information activities; prepares and disseminates routine information (eg. quarterly newsletter);

carries out research and obtains and distributes development and other information to the entire Mission;

and supports all VIP visits and special events; assists in communicating with GFATM, World Bank and other

donors.

Contract/Program Support Specialist (2) (FSN) - The incumbent will assist the Technical PHA to monitor

technical and financial activities for cooperative agreements and assist technical staff in meeting

cooperative agreement objectives. The rapid increase in the number of such agreements requires

additional staff time to effectively manage and monitor them.

Subpartners Total: $0
FHI 360: NA
Cross Cutting Budget Categories and Known Amounts Total: $0
Food and Nutrition: Commodities $0