The AIHA Twinning Center proposes to create, manage, evaluate, and provide technical assistance to a

partnership between a TBD partner from Brazil and one or more Mozambican organizations to increase TB

literacy at the community level.

Currently in Mozambique, there is a lack of information on tuberculosis at all levels of the healthcare

system. Healthcare workers are beginning to receive information and training from the Ministry of Health,

but little effort has been done to educate community and home- based care providers. Brazilian

organizations have considerable experience in community education on tuberculosis, including educating

those infected with HIV and or TB to provide outreach to others.

The Twinning Center will work with key US government supported organizations in Mozambique and Brazil

to identify the appropriate partners from each country. The Brazilian partner will likely be a local or

international organization currently supported by the US government, whereas the Mozambican partner will

likely be a local organization. This partnership will focus on the development and dissemination of materials

to educate the community about TB/HIV co-infection and educate community care providers on recognition

of signs and symptoms of TB in PLWHAs.

Project Management

The Twinning Center will work with the association partnership to develop a workplan including goals and

objectives, partnership communication plan, and monitoring and evaluation plan. Both partners will identify

partnership coordinators who work with Twinning Center staff to monitor the partnerships' progress and to

help identify areas where technical assistance might be required. The Twinning Center will also be

responsible for day-to-day project administration including program implementation, budget monitoring, and

logistical support. The Twinning Center can also provide training to the individual organizations on financial

administration and subgrant management.

For the multitask counselor assessment, the Twinning Center will identify appropriate individuals to provide

the technical assistance to the Ministy of Health. It will ensure close coordination with stakeholders at all

times and collaboration to create a scope of work and defined responsibilities which are reasonable and

accepted by the Ministry of Health.

Monitoring and Evaluation

AIHA Twinning Center staff will assist partners to develop and implement a monitoring and evaluation

system for the partnership. In collaboration with USG stakeholders, AIHA and partners will select the

appropriate PEPFAR indicators and other relevant indicators based on planned activities in the workplan.

AIHA will assist partners to develop the appropriate tools and systems necessary to collect and report

relevant data and provide technical assistance when necessary. AIHA will report this data to USG teams

quarterly and will further evaluate the partnership's effectiveness in meeting its goals and objectives upon

completion of the workplan period.

Twinning Partnership Philosophy

In keeping with its mission to advance global health through partnerships that mobilize professionals,

institutions, and communities to better address delivery and quality of health care, the American

International Health Alliance established the Twinning Centre to help integrate and improve HIV/AIDS

prevention, care and treatment in the countries most affected by the global AIDS pandemic. Operating

under a cooperative agreement with the Health Resources and Services Administration (HRSA), and in

collaboration with the various USG agencies coordinating the President's Emergency Plan for AIDS Relief

(PEPFAR), the Twinning Centre establishes and manages both north- south and south-south partnerships

which focus on strengthening institutional capacity to create a sustainable response to the HIV pandemic.

The partnerships focus on a peer-peer methodology and leverage resources through volunteerism and in-

kind contributions. Most twinning partnerships are able to leverage substantial resources to greatly

increase the value of the partnership.

In keeping with its mission to advance global health through partnerships that mobilize professionals,

institutions, and communities to better address delivery and quality of health care, the American

International Health Alliance (AIHA) established the Twinning Centre (TC) to help integrate and improve

HIV/AIDS prevention, care, and treatment in the countries most affected by the global AIDS pandemic.

Operating under a cooperative agreement with the Health Resources and Services Administration (HRSA),

and in collaboration with the various USG agencies coordinating the President's Emergency Plan for AIDS

Relief (PEPFAR), the Twinning Centre establishes and manages both north-south and south-south

partnerships which focus on strengthening institutional capacity to create a sustainable response to the HIV

pandemic. The partnerships focus on a peer-peer methodology and leverage resources through

volunteerism and in-kind contributions. Most twinning partnerships are able to leverage substantial

resources to greatly increase the value of the partnership.

Since 2005, AIHA/TC has been providing TA to MOH regarding activities related to Prevention with

Positives.

For FY08 the proposed new Counseling and Testing (CT) activities are:

1) Create a partnership with the Kenyan Association of Professional Counselors:

Currently there is a cadre of lay counselors in Mozambique who are providing Counseling and Testing (CT)

services, mostly through USG partners. There is a need to strengthen the capacity of lay counselors to

provide betters services and organize themselves to access each other as resources for information,

exchange of ideas, and addressing common issues such as counselor burn-out. This partnership will bring

together the Kenyan Association of Professional Counselors and selected counselors throughout

Mozambique to strengthen their access to resources in training, sharing information, and communication.

This activity will enable Mozambican counselors to explore potential possibilities to organize themselves as

a group of professional cadres and to create a sustainable environment to build on training and exchange of

resources.

2) Provide technical assistance (TA) to the Ministry of Health CT, human resources, and training

departments to conduct a task analysis for "multi-task counselors" and propose a scope of work for this new

cadre:

In an effort to create a cadre of multi-task counselors who can provide counseling and testing for HIV in CT

sites and clinical settings, appropriate referrals for HIV positive and negative clients, counseling for

treatment and treatment education among many other duties, technical assistance will be provided to the

Ministry of Health to define the role of a multi-task counselor and outline responsibilities for this professional

cadre. The technical assistance will include close collaboration with stakeholders, particularly the CT,

human resources, and training departments within the Ministry of Health. It will examine what kind of cadre

of counselors Mozambique could consider to improve its CT services. The outcome will be the development

of a scope of work for multi-task counselors, who will be able to take on non-clinical tasks to-date mostly

taken on by nurses, and contribute to task-shifting efforts.

The Twinning Center will work with the association partnership to develop a work plan including goals and

objectives, partnership communication plan, and monitoring and evaluation plan. Both partners will identify

partnership coordinators who work with Twinning Center staff to monitor the partnerships' progress and to

help identify areas where technical assistance might be required. The Twinning Center will also be

responsible for day-to-day project administration including program implementation, budget monitoring, and

logistical support. The Twinning Center can also provide training to the individual organizations on financial

administration and subgrant management.

For the multitask counselor assessment, the Twinning Center will identify appropriate individuals to provide

the technical assistance to the Ministry of Health. It will ensure close coordination with stakeholders at all

times and collaboration to create a scope of work and defined responsibilities which are reasonable and

accepted by the Ministry of Health.

AIHA Twinning Center staff will assist partners to develop and implement a monitoring and evaluation

system for the partnership. In collaboration with USG stakeholders, AIHA and partners will select the

appropriate PEPFAR indicators and other relevant indicators based on planned activities in the work plan.

AIHA will assist partners to develop the appropriate tools and systems necessary to collect and report

relevant data and provide technical assistance when necessary. AIHA will report this data to USG teams

quarterly and will further evaluate the partnership's effectiveness in meeting its goals and objectives upon

completion of the work plan period.

2) Provide technical assistance to the Ministry of Health CT, human resources and training departments to

conduct a task analysis for "multi-task counselors" and propose a scope of work for this new cadre

according to findings.

In effort to create a cadre of multitask counselors who can provide counseling and testing for HIV in CT

sites and clinical settings, appropriate referrals for HIV positive and negative clients, counseling for

treatment and treatment education among many other duties, technical assistance will be provided to the

Ministry of Health to define the role of multitask counselor and outline responsibilities for this professional

cadre. The technical assistance will include close collaboration with stakeholders, particularly the CT,

human resources and training departments within the Ministry of Health. It will examine what kind of cadre

of counselors should Mozambique consider to improve its CT services and how to more effectively use of

counseling and testing as a preventive measure. The outcome will be the development of a scope of work

for multitask counselors, who will be able to take on lower-level nursing responsibilities and contribute to

task-shifting efforts. Further, suggestions will be made on the implementation of this new cadre of

professionals.

Project Management

The Twinning Center will work with the association partnership to develop a workplan including goals and

objectives, partnership communication plan, and monitoring and evaluation plan. Both partners will identify

partnership coordinators who work with Twinning Center staff to monitor the partnerships' progress and to

Activity Narrative: help identify areas where technical assistance might be required. The Twinning Center will also be

responsible for day-to-day project administration including program implementation, budget monitoring, and

logistical support. The Twinning Center can also provide training to the individual organizations on financial

administration and subgrant management.

For the multitask counselor assessment, the Twinning Center will identify appropriate individuals to provide

the technical assistance to the Ministry of Health. It will ensure close coordination with stakeholders at all

times and collaboration to create a scope of work and defined responsibilities which are reasonable and

accepted by the Ministry of Health.

Monitoring and Evaluation

AIHA Twinning Center staff will assist partners to develop and implement a monitoring and evaluation

system for the partnership. In collaboration with USG stakeholders, AIHA and partners will select the

appropriate PEPFAR indicators and other relevant indicators based on planned activities in the workplan.

AIHA will assist partners to develop the appropriate tools and systems necessary to collect and report

relevant data and provide technical assistance when necessary. AIHA will report this data to USG teams

quarterly and will further evaluate the partnership's effectiveness in meeting its goals and objectives upon

completion of the workplan period.

AIHA will continue to implement Prevention with Positives (PwP) programs in the six existing sites in

Mozambique. In 2006, AIHA developed and initiated a partnership between the University of California, San

Francisco and two HIV/AIDS service sites in the Maputo Province: Namaacha Health Center and

Esperanza-Beluluane VCT Center. Since 2006, partners have joined efforts to conduct and develop

programs and interventions, specifically targeting the clientele at each site. Working under the assumption

that the patient-provider relationship contains vast opportunities to carry-out HIV-transmission interventions,

partners developed provider and patient specific goals and objectives to track behavior changes in both

populations. The primary goals of the intervention are the same: both the health care providers from

Namaacha Health Center, and community based workers and PLWHA support group members from

Beluluane-Esperanza VCT Center develop skills to address the prevention needs of HIV-infected individuals

accessing their services or participating in PLWHA support group activities. This includes discussions

about:

• HIV risk behavior

• Counseling and support

• How to disclose HIV to partners and family members

• How to produce or maintain healthy families

• Individualized prevention plans and risk reduction techniques

Currently this program is in the scale up phase, where the overall partnership is to provide healthcare

workers at the facilty-based site amd PLWHA and counselors at the community-based site with the

competencies, comfort, and the desire to discuss risk behavior and prevention needs, thereby decreasing

HIV transmission, and encourage HIV testing (including partner testing). During FY07, the project has met

with additional sites and other stakeholders and proposed to expand to include 4 additional sites, 2 sites in

Sofala Province and 2 site in Zambezia Province. In Sofala, a VCT satellite center in Mutua District has

been proposed for the community-focused intervention and the Ponte Gea Hospital de Dia, in Beira for the

provider focused intervention. In Zambezia Province ,the community-focused intervention was proposed for

Namacurra District working with Chinde community and provider focused intervention for the Namacurra

Health Centre.

In FY08, the partnership focus will be on the completion of solid training materials and an intervention

package designed and developed thorugh the work at the above described pilot or demonstration sites, to

now make these materials available for other sites and partners in Mozambique to develop PwP programs.

The partnership will train other partners to develop their own individual PwP programs and prevention

messages.

Additional PwP activities will include a ToT for facility based care and treatment program managers and

staff including the provision of PwP toolkits to staff and participating organizations; a PwP ToT for

community based care and treatment program managers and staff targeting national NGOs and CBOs; and

a study tour for PwP implementors in-country to visit other PwP sites to establish close collaboration among

all sites. Partners will continue to suppport existing PLWHA groups through either small sub-grants and/or

procurement of items needed by the group (e.g. seeds, T-shirts, transport funds for ART sites, etc).

Partners will explore collaboration opportunities with a nascent Mozambican treatment literacy organization

(MATRAM) to incorporate PwP messages into their activities. This initial exploration is expected to lead to

strengthening of partnerships in the subsequent year. In addition, project implementers will develop partner

opportunities with the organization Women Organized to Respond to Life-Threatening Diseases (WORLD)

and a TBD Mozambican Womens' Association(s) to create prevention messages targeting women and

women's empowerment opportunities.

Measurable project outcomes tracking behavior changes in PLWHA and direct service providers and

implementing and managing M&E systems and toos to monitor outcomes. It is anticipated that 195

individuals (both service providers and individuals) will receive prevention with positives training.

Goals

Although continued specific partnership objectives will be jointly developed by both partners, AIHA and CDC

-Mozambique during workplan development, initial focus areas, based on AIHA's experience thus far,

include the following: (a)To increase the knowledge and skills of healthcare workers, counselors and

PLWHA peer educators to address prevention counseling, adherence counseling, disclosure of HIV status,

partner notification and risk reduction techniques among PLWHA; (b)To increase the capacity of staff and

PLWHA peer eductaors at the PwP program sites to monitor and evaluate PwP activities; and (c) To

increase the level of PLWHA patient monitoring/surveillance in conjunction with PwP activities.

Project Management

Twinning Center staff in Washington DC will continue to work with and support this partnership by

developing a workplan including goals and objectives, partnership communication plan, and monitoring and

evaluation plan. Both partners have identified partnership coordinators who work with Twinning Center staff

to monitor the partnerships' progress and to help identify areas where technical assistance might be

required. The Twinning Center will also be responsible for day-to-day project administration including

budget monitoring and logistical support. The Twinning Center can also provide training to the individual

organizations on financial administration and subgrant management.

Monitoring and Evaluation

AIHA Twinning Center staff and UCSF technical and PwP experts have assisted partners to develop a

monitoring and evaluation system for the partnership. AIHA and UCSF will continue to assist the partners in

implementing this system and developing training-specific monitoring tools. In collaboration with USG

stakeholders, AIHA and partners will continue to select the appropriate PEPFAR indicators and other

relevant indicators based on planned activities in the workplan. AIHA and UCSF continue to assist partners

to develop the appropriate tools and systems necessary to collect and report relevant data and provide

technical assistance when necessary. AIHA reports these data to USG teams quarterly and will further

evaluate the partnership's effectiveness in meeting its goals and objectives upon completion of the workplan

period.

Twinning Partnership Philosophy

In keeping with its mission to advance global health through partnerships that mobilize professionals,

Activity Narrative: institutions, and communities to better address delivery and quality of health care, the American

International Health Alliance established the Twinning Centre to help integrate and improve HIV/AIDS

prevention, care and treatment in the countries most affected by the global AIDS pandemic. Operating

under a cooperative agreement with the Health Resources and Services Administration (HRSA), and in

collaboration with the various USG agencies coordinating the President's Emergency Plan for AIDS Relief

(PEPFAR), the Twinning Centre establishes and manages both north- south and south-south partnerships

which focus on strengthening institutional capacity to create a sustainable response to the HIV pandemic.

The partnerships focus on a peer-peer methodology and leverage resources through volunteerism and in-

kind contributions. Most twinning partnerships are able to leverage substantial resources to greatly

increase the value of the partnership.

This activity is also linked to Activities 8639 and 8632.

The USG's SI team's primary challenge in collaborating with the Ministry of Health (MoH) on key public

health evaluations and routine data analysis is the limited number of trained staff working at a technical

level high enough to support these monitoring and evaluation (M&E) activities. Of specific concern is the

entire lack of staff with the capacity to support the SI Team's principle strategy: to address issues around

the quality of service delivery for HIV care and treatment programs. Additionally, there are no accredited

PhD programs in M&E or public health in Mozambique that can help to build this capacity in the future.

Accordingly, with proposed USG FY07 funds, we will support long-term M&E training for one candidate with

an M.D. currently working in the MoH's National Institue of Health (INH). The selected candidate, who has

been in the MoH for 10 years, will attend an accredited PhD program at a foreign university in health policy,

planning and financing. This area of study is directly related to program monitoring and evaluation for quality

service delivery improvement. As previously mentioned, there are no in-country opportunities to receive this

training at a local university.

To ensure that the MoH and the USG receive maximum benefit from this long-term training, the candidate

has agreed that his dissertation will focus on the Cost Effectiveness M&E PHE evaluation described in

Activity 8639 and related to Activity 8632. In addition, he will sign a return commitment letter as described in

PEPFAR's long term training guidance. We anticipate that the outcomes of the PHE will be more robust

with the involvement of this MoH in this capacity.

Federal Universityof Rio De Janeiro will provide long term training in Brazil to a clincial pathologist from

Mozambique. It is expected that the Mozambician pathologist will be able to draw on experiences and

resources obtained while in Brazil to strengthen and reinforce the national lab services in Mozambique.

CONTINUATION: The American International Health Alliance's Twinning Center proposes to continue a

partnership between Catholic University of Mozambique (UCM) and University of Pittsburgh ($450,000). To

date, partners have jointly conducted scale-up activities of Catholic University's HIV/AIDS training center.

Partners have defined clinical competencies and designed practical hands-on training sessions for UCM

faculty and staff. In addition, partners have established formal relationships with local HIV treatment clinics

to serve as sites for the practical component of the training; developed M&E capacity at UCM for measuring

quality and effectiveness of trainings; developed and trained faculty for each training track, based on MOH

guidelines; trained ICSB instructors; trained in-service healthcare workers based on MOH priorities; and

trained orderlies in universal precautions/infection control.

FY08 activities will focus on creating practical, hands-on training within the outpatient facility, which was

renovated by the partnership in FY 2006-2007, to train the medical students and other personnel in

outpatient HIV and other Opportunistic Infections, such as TB, and Malaria. Although medical students will

be the primary recipient for trainings, partners will design and implement additional trainings specifically for

nurses, pharmacists, midwives, and laboratory technicians who are working in Sofala Province. In addition,

FY08 activities will focus on integrating coursework of UCM to include the many areas of HIV prevention,

care, and treatment into the training curricula. The partnership expects to provide HIV care and treatment

services for approximately 300 individuals receiving services at the hands-on outpatient facility. It is also

anticipated that 15 UCM faculty and staff trained on coordination of healthcare services and to increase

client retention in antiretroviral treatment programs,

33 UCM faculty and staff trained to provide quality HIV/AIDS treatment and training services and 350

medical students and other professionals trained on DPS' priorities in HIV clinical management.

CONTINUATION: ANEMO (Mozambician Nurses Association) ($225,000) and a TBD twinning partner.

Focus of FY 08 activities are on developing a new twinning partnership focused on developing ANEMO as a

professional nursing association. The previous twinning partner, APCA (African Palliative Care Association)

resulted in progress in assessing ANEMO's organizational structure and developing a strategic plan to

strengthen the organization. In FY08, emphasis will be on developing a business plan to strengthen

membership, identify and market services provided by the association and sustainability of the association.

NEW: TBD partner ($50,000) focusing on the long term training of a clinical pathologist at a higher

education institution in Brazil. It is expected that the Mozambician pathologist will be able to draw on

experiences and resources obtained while in Brazil to strengthen and reinforce the national lab services in

Mozambique.

Project Management

Twinning Center staff will continue to work with the partnerships to develop a 12-month workplan including

goals and objectives, partnership communication plan, and monitoring and evaluation plan. Partners will

identify partnership coordinators who work with Twinning Center staff to monitor the partnerships' progress

and to help identify areas where technical assistance might be required. The twinning center will also be

responsible for day-to-day project administration including budget monitoring and logistical support. The

Twinning Center can also provide training to the individual organizations on financial administration and

subgrant management.

Monitoring and Evaluation

In collaboration with USG stakeholders, AIHA and partners will continue to select the appropriate PEPFAR

indicators and other relevant indicators based on planned activities in the workplan. AIHA continues to

assist partners to develop the appropriate tools and systems necessary to collect and report relevant data

and provide technical assistance when necessary. AIHA reports these data to USG teams quarterly and will

further evaluate the partnership's effectiveness in meeting its goals and objectives upon completion of the

workplan period.

Deliverables/benchmarks (Catholic University):

• Clinical practicum training located within an outpatient clinic located on the university campus for training

medical students, nursing students from a nearby MOH training institution and practitioners from the local

community

• HIV care and treatment for 300 individuals who attend the clinical site

• Training of faculty on coordination of healthcare services and client retention in ARV treatment programs

Deliverables/benchmarks (ANEMO):

• New twinning center partner

• Business plan to strengthen membership, identify and market services provided by the association and

sustainability of the association

Deliverable/benchmark (TBD):

• Long term training of a clinical pathologist at a higher education institution in order to strengthen and

reinforce the national lab services in Mozambique