Per guidance sent by CDC/GAP, this activity represents approximately 1/12 of the funding originally

allocated to Columbia University for this program area under activity 5181.08. Funding is provided to pay

for that activity from February 23 - April 1, 2009.

Continuing activity: Columbia University's (CU) scale-up of treatment services is supported by USG and

guided by Mozambique's national HIV strategic plan. In collaboration with the Ministry of Health (MOH), CU

will continue long-standing support HIV care and treatment facilities at 10 secondary and tertiary-level

hospitals in Maputo City (3), Xai Xai in Gaza Province (1), Inhambane City in Inhambane Province (1),

Nampula City in Nampula Province (1), and Quelimane, Mocuba, Milange and Gurue in Zambezia Province

(4). To accomplish this, CU will continue to:

1) finance, train and mentor 15-20 MOH clinic staff per facility (200 total),

2) provide equipment and supplies to maintain facility operations,

3) conduct additional renovations as needed,

4) improve patient management, drug management and strategic information systems,

5) reinforce follow-up and referral systems,

6) strengthen linkages with organizations providing services for PLWHA, VCT outlets, TB clinics and

pMTCT centers

7) strengthen linkages with services to increase HIV case-finding (e.g. TB, PMTCT, Youth Centers)

Specific activities include:

Human Resources: Continue financing the salaries of MOH health-care workers (200). These providers

include, doctors, medical technicians, nurses, counselors, pharmacists, data technicians and administrative

staff. This activity will be financed through subagreements with Provincial Health Authorities (DPS) plus the

Central Hospital in Maputo.

Training and Mentoring: Continue supporting CU clinical-support teams at the facility level. The clinical-

support teams provide clinical mentoring, technical assistance and logistical support to staff at the HIV care

and treatment facilities supported by CU. They provide refresher training for facility staff to reinforce

guidance received through national training programs. The teams are based at provincial-level hospitals

and travel regularly to other CU-supported facilities in the province. Each team includes a Clinical

Supervisor, 1-3 Clinical Officers, 1-2 Logistics Officers and a Data Officer. All team members are hired

directly by CU.

Infrastructure: Continue providing supplies and additional equipment to maintain and expand facility

services. In addition CU will support minor renovations as needed.

In addition, CU will continue to provide technical support at the central level to the Department of Medical

Assistance (DAM). This support is used to assist the Government of Mozambique in developing and

updating policies and guidelines for managing the national ART effort. Specifically, CU technical staff will

provide the following support: guidance to HIV Management and ARV Committees, revision of clinical

guidelines and HIV service decentralization plan, revision of training curricula and materials, adaptaion of

adherence and psychosocial support materials and guidance to the National Adherence Support Work

Group, and refinement and roll-out of a CU-developed computer and paper-based patient-tracking system

system.

As an integral part of its efforts, CU will work to improve pediatric treatment services and support at least

3,800 children on treatment and 22,000 children receiving HIV care at all CU supported facilities.

FY07 Narrative: This activity is linked to activities 8593 and 8545.

Columbia University's (CU) proposal for FY07 Track 1 funds and in-country supplemental funding in the

amount of $5,411,250 builds on FY04-FY06 treatment activities. With this funding, CU will support the

Ministry of Health (MoH) in the provision of ART treatment to 25,500 PLWHAs (23,000 with ongoing Track 1

Funding) and the expansion and improvement of service referral networks.

To achieve this target, CU will increase its current number of treatment sites from 18 currently to 24 in FY06

and 36 in FY07. CU's expansion is guided by the USG PEPFAR team's five-year strategic vision that ARV

treatment services should reach beyond provincial capitals to include rural health facilities. The additional

facilities supported in FY07 (primarily through the supplemental funding) will be outside major urban cities.

Beyond direct support of patients on ARV therapy, specific activities to be undertaken with Track 1 funds

include:

1) Human Resources: CU will continue to supplement existing staff at 24 HIV care and treatment facilities

by financing, training, and providing ongoing mentorship to 15-20 MoH clinic staff per facility in the provision

of HIV care and treatment services for adults and children (400 staff total). These providers include doctors,

medical technicians, nurses, counselors, pharmacists, data technicians and administrative staff. This

relationship and support contributes to skills building and transfer at the point of service delivery.

Human Resource staffing is financed through sub agreements with Provincial Health Authorities in the six

provinces supported by CU plus the Central Hospital in Maputo City.

Training: CU will continue to provide ongoing training by clinical-support teams to staff working at CU HIV

care and treatment facilities in 6 provinces plus the Central Hospital in Maputo. Each team includes a

Clinical Supervisor, 1-3 Clinical Officers, 1-2 Logistics Officer and a Data Officer. In particular, they provide

refresher training for all health care providers to reinforce national guidelines and centrally-developed

training programs. The teams also conduct on-site training and mentoring of clinicians in the management

of HIV-exposed infants at CU-supported pMTCT facilities

All team members are hired directly by CU, based at Provincial Hospitals, and regularly travel to CU-

supported facilities.

3) Infrastructure: CU will continue to provide supplies and additional equipment to maintain and expand

services at 24 facilities through FY06. In addition CU will conduct renovations to existing health facilities as

needed.

Activity Narrative: 4) Policy and guidelines: CU will continue to provide technical support at the central level MOH to the

Department of Medical Assistance (DAM). This support contributes to the development of policies and

guidelines for managing the national ART effort. Specifically, CU technical staff will assist the HIV

Management and ARV Committees to develop and revise clinical guidelines and an HIV service

decentralization plan in addition to designing/updating training curricula and materials. CU will also work

with the National Adherence Support group to develop adherence and psychosocial support materials.

Internally, CU will work to strengthen their electronic patient-tracking system and paper-based systems for

program monitoring purposes and will advise Emergency plan staff and other partners on the process for

renovation of MOH facilities, including design, tendering and implementation.

4) Coordination: Columbia University will continue to participate in coordination meetings of the PEPFAR

treatment partners as well as quarterly PEFAR partners meetings to ensure exchange of information,

coordination of Emergency plan efforts and to provide regular updates of the program during the course of

implementation.