Reprogramming August08: Funding decrease by$542,597.

Continuing activity under COP08.

EGPAF will move towards a district level approach in support of a scaleable PMTCT model, a technical

approach that accounts for the doubling of sites in this activity. More attention is focused on significant

expansion within the districts where EGPAF provides support, including support to the District Health Officer

and the Provincial Health Director to achieve and manage this expansion of PMTCT services, than

expansion into districts where EGPAF is currently not active.

EGPAF will also support pre-service training costs for 35 nurses in Nampula province, human resources

being a key strategy in scaling up the PMTCT program. The program will continue to foster linkages with

the Child at Risk Consult (CCR) as well as treatment services. The referral system between PMTCT,

treatment services, and the CCR will be the first line of approach, which has broad Governmental support.

However, the program will also explore manners to reinforce testing and treatment linkages with vaccination

campaigns, well baby visits, and weighing stations.

Using COP 07 plus up funds, PSI will map existing PEPFAR and non-PEPFAR partner interventions in

PMTCT and overlay this map with mosquito net distribution data from the President's Malaria Initiative (PMI)

and other donors and partners (Malaria Consortium, Government of Japan, the Global Fund, etc). The

assessment will be a gaps analysis of where present activities under PEPFAR, PMI, and other partners are

taking place and where, geographically and programmatically speaking, more concerted and coordinated

action is needed by the consortia of actors. PEPFAR and PMI will leverage each others' resources with

PMI providing the vast amount of LLINs for distribution to pregnant and lactating mothers. However,

PEPFAR, through PSI, will provide a buffer stock of LLIN for PMTCT partners to ensure that all pregnant

women receive a mosquito net. Finally, PMTCT partners will be crucial partners to PMI for the routine

integration of at least two doses (of the recommended three) of SP.

The program will also partner with WFP to support the nutritional needs of the most vulnerable PMTCT

clients through provision of short-term emergency food support. Please refer to the activity sheet for WFP

for funding levels and targets.

The FY2007 narrative below has not been updated.

Plus-Up Change: EGPAF will start PMTCT services in an additional 9 sites, making essential services for

the prevention of pediatric AIDS available in more remote settings. In Cabo Delgado and Nampula this

implies expansion into additional districts where currently no PMTCT services are available. In Gaza and

Maputo, EGPAF will move into additional peripheral sites to ensure increased coverage of PMTCT services

in these high prevalence provinces. In these new sites, EGPAF will reach an additional 4,800 women with

HIV testing services during pregnancy and aims to provide ARV prophylaxis to an additional 360 HIV

positive women.

Support will include basic and on the job training in PMTCT and counseling and testing, formative

supervision and technical support to clinical services as well as psychosocial services for identified HIV

positive women, including support to the establishment of support groups. Throughout the program, greater

emphasis will be placed on primary prevention among women testing HIV-negative. EGPAF will also work

to increase rates of exclusive breastfeeding, as a strategy to reduce pediatric infections but also improve

the health off all children in these settings with high rates of malnutrition and infant mortality. Finally,

EGPAF will hire a PMTCT technical advisor for the province of Cabo Delgado to assist the DPS in

improving the quality and quantity of PMTCT services within the province, especially in sites that receive no

direct NGO support. EGPAF will support the provincial PMTCT advisor with funds to assist in supervisory

visits, petrol, and communications. FY06 program goals for EGPAF/Mozambique focused on 1) support to

the Mozambique National PMTCT program 2) use of PMTCT to identify HIV infected individuals, and to link

to care and treatment services for families; and 3) strengthening of MCH services, especially capacity

building at the Provincial and District level health care system. During 2006 PMTCT services were

supported in 18 sites, including three referral maternities.

As of June 2006 the Foundation's PMTCT program has provided 23,830 women with HIV counseling and

testing, identified 3,136 as HIV positive, provided 1,533 HIV positive pregnant women with ARV prophylaxis

and 1,608 HIV exposed infants with ARV prophylaxis. In 8 of the supported sites, treatment programs were

established with support from the Foundation (USG/CDC funds), increasing access to ARV treatment for

pregnant women in need of treatment and HIV infected infants and children. For FY2007, EGPAF is

requesting funds from USAID for the continuation and expansion of PMTCT services as well as funds from

CDC to continue to provide antiretroviral treatment (ART) with a family focused approach and to expand to

additional sites. This expansion of ART programs include the planned new PMTCT sites so that

comprehensive PMTCT programs will also provide access for ARV treatment for pregnant women and

mothers who need this for their own health. The presence of an ART program in these sites will also

facilitate the provision of more complex and effective prophylactic regimens.

The Foundation's plans in FY07 are to continue providing comprehensive PMTCT services in existing sites

with a focus on improving quality of services and increasing coverage by supporting the DDS to expand into

peripheral sites within district programs. In addition, during the next year the Foundation plans to expand

into Moamba District in Maputo Province and Nametil District in Nampula province and add four sites in

Cabo Delgado. Technical assistance and support will focus on improving monitoring and evaluation

systems and moving to provide routine counseling and testing in both the antenatal care and labor and

delivery settings in all sites.

The Foundation's PMTCT program will continue to provide a comprehensive package of care and will work

to accelerate implementation of key services including the provision of more complex prophylactic regimens

for HIV positive women with CD4 counts over 350, integration of family planning, malaria prophylaxis and

TB screening services and further emphasis on improving HIV positive eligible women's access to ART.

Improving health work skills in staging and screening patients will help decrease loss to follow-up.

Follow up of mother and infant pairs will also receive increased attention. The Foundation staff will provide

technical support to the Mozambique MOH for the revision of the national child health card. The new card

designs will capture information on HIV exposure. In addition, identification of HIV exposed infants will be

improved by training staff in well child clinic (WCC) to look for HIV exposure status on the infant card and

inquire if status is missing.

Improvement of the Child at Risk Clinic (Consultas de Crianças em Risco) will also continue for follow up

care of HIV infected mothers not eligible for ART at CCR. Early identification of HIV exposed infants will

allow early testing and identification of HIV infected infants and timely initiation of treatment services and

ultimately lower morbidity and mortality rates for these children. Therefore the Foundation will provide

support to the roll-out of DNA-PCR into its supported sites as per MOH implementation strategy. Mother

infant pairs who do not return to formal health services will be followed up in the community by volunteers

from the Community based organizations that the Foundation has started to support in FY2006.

The Foundation will continue to strengthen existing Mozambican community-based organizations (CBO) to

Activity Narrative: mobilize for PMTCT and provide support to HIV positive pregnant women, infants and their families. As the

prevention of unintended pregnancies is a core strategy of PMTCT, the Foundation will implement specific

activities to strengthen Family Planning services within the PMTCT program. This will include the training of

health staff aimed at strengthening Family Planning services within PMTCT, the roll out of the FSG manual

(developed in FY06) which includes a module on FP, and improve the inclusion of men by couples

counseling in ANC and maternity.

April08 Reporgramming Change: Reduced $200,000. This request for re-programming of funds originally

attributed to EGPAF is based on two separate but inter-related issues. First, EGPAF's burn rate in the last

amendment to the cooperative agreement was slower than expected; a no cost extension was requested

and granted to EGPAF and the adjustment to the dates will mean that EGPAF will be unable to use the

entirety of the funds we had originally planned. Second, closer inspection of their budget indicates that two

activities are duplicative with other partners; these activities have been removed from their project

description. Future re-programming is anticipated in modest sums.