Vanderbilt University / Friends in Global Health (VU/FGH) is currently providing adult and pediatric HIV care

and ART treatment services in 4 districts in Zambézia Province with expansion planned in 2 more districts.

FY08 support will be used to continue work in supported sites that do not have an existing PMTCT partner

in 4 established districts, and expansion efforts will include additional new sites in these 4 districts and 2

additional neighboring districts. At the completion of FY08,VU/FGH will support 22 total sites in 6 districts,

including 4 mobile clinics (1 in each of 4 districts). Currently, other PEPFAR funded partners are providing

PMTCT support in the district capital hospitals within the abovementioned districts. VU/FGH would like to

complement this support by providing PMTCT support in the peripheral areas of these districts, at sites not

receiving PMTCT support from other partners.

VU/FGH expects approximately 13,200 women to seek care at supported sites in FY08; more than 90% will

be provided with HIV counseling and testing, and among approximately 15% expected to be HIV infected,

60% will receive a complete course of ARV prophylaxis.

VU/FGH will implement PMTCT services according to MISAU guidelines. We will provide support for

infrastructure development, staffing, clinical supervision and mentoring, training for PMTCT providers,

adherence and psychosocial support for HIV infected pregnant women and mothers, PMTCT monitoring

and evaluation, community outreach including mother to mother support groups. VU/FGH will also

collaborate with partners to facilitate laboratory activities such as hemoglobin testing, CD4 counts, and early

infant diagnosis.

At VU/FGH PMTCT sites, we will facilitate linkages with services (i.e. VCT, TB program, ART treatment, and

antenatal clinics) to ensure appropriate referral of eligible pregnant women into treatment in a timely

manner; appropriate referral of newborns into at-risk child consultations; appropriate monitoring of at risk

women (i.e. discordant couples) and referral into PMTCT services as needed; appropriate referral into USG

supported service programs such as the Presidents Malaria Initiative; and access to mother support groups.

In-service training and mentoring will be provided to PMTCT staff at supported sites to provide clinical

updates, refresh PMTCT service delivery knowledge and skills, and assure quality PMTCT activities.

Reprogramming August08: Funding increase $200,000. Additional activities around Caring for Carers will

be added to the Vanderbilt's activities. In a plan developed through dialogue with the Ministry of Health, this

could involve an exchange experience with Brazil who have developed an accessible "Community Therapy"

model of support to caregivers, as well as the development and piloting of a caring for caregivers training

module, establishing functional support groups for caregivers, training organizational staff on how to provide

training and support for caregivers, and reinforcing links between community organizations and clinical

facilities.

Friends in Global Health - FGH (Vanderbilt University) activities for Palliative Care: Basic health care and

support, including direct implementation activities in Zambézia Province and systems strengthening at the

Central, Provincial and District levels.

Implementation activities in Zambezia Province:

Vanderbilt U./Friends in Global Health is currently providing adult and pediatric HIV care and ART treatment

services in 4 districts in Zambézia Province (Alto Molocue, Ile, Namacurra, Inhassunge), with expansion

planned in 2 more districts (Gile, Lugela). Treatment site expansion will continue to support on-going work

in 7 currently supported sites (Alto Molocue, Nauela, Ile, Mogulama, Namacurra, Macuze, Inhassunge)

within 4 districts and expand to include 4 sites in each district (24 sites in 6 districts) plus the addition of 4

mobile clinics total in 4 districts. This district-wide expansion will result in a total of 28 points of service in the

six districts supported by FGH/VU.

• Support implementation and maintenance of information system to monitor HIV-related palliative care

activities

• Support project data collection by the National AIDS Council (CNCS) for accurate and updated mapping of

NGO activities

• Support SDSAS (District Health and Social Service Department) to coordinate HBC activities in each

district

• Designate and support a focal point in each FGH-supported health facility to coordinate with health

(including HBC), social, legal, and other services available to PLWHA

• Support the formation and functioning of PLWHA groups

• Support ANSA (Food Security and Nutrition Association) to train PLWHA and their families on best

nutritional practices using locally available products

• Support coordination with WFP and UNICEF in distribution of nutritional supplements for eligible PLWHA

including children

• Support Medical Service Corporation International (MSCI) and/or local community organization to start

HBC and HIV-related palliative care services in localities where such services are not yet available

• Support the implementation of a minimum package of services provincially, to include the distribution of

ITBN (Insecticide Treated Bednets) in coordination with PMI and the distribution of certeza

• Support pilot activities in two districts for PLWHA transportation systems to reach points of service

Targets:

As a result of these activities, the following targets will be achieved:

Number of service outlets providing HIV-related palliative care: 28*

Number of individuals provided with HIV-related palliative care: 6250*

Number of individuals trained to coordinate HIV-related palliative care based in Health Facilities: 56

* (clinical + community based)

Systems Strengthening activities:

VU/FGH will provide technical support to the MOH, MMAS, and CNCS in systems strengthening

(coordination and referral systems, materials development, M&E, supervision tools, policy development,

etc), including support of the National Mozambican Women's Organization (OMM) for their care, support

and training activities. Activities include:

• OMM - Care, support and Training Center in Gaza Province

• Twinning support with South African multi-service centers and the OMM in: changing cultural norms,

gender-based violence, economic support (income generating activities such as soap making and others)

• Support MOH in the development and revision of HBC materials and ensure the incorporation of palliative

care concepts in the new Community Health Worker materials

• Provide MOH with technical support on Palliative care and Food policy

• Provide initial and ongoing technical support to MMAS in the development of psycho-social support and

other materials related to the implementation of Integrated Care and support systems

• Provide support to MMAS for supervision, M&E, and QA of HIV-related social support activities

• Develop an M&E framework for an Urban HBC model to measure quality and inform policy development in

this area

• Provide technical support to CNCS to develop a plan to strengthen coordination with the MOH in the

selection of HBC/OVC proposals to roll-out with ART

• Support the development and implementation of standard tools for mapping health and social services

including HBC, legal services, and other services available to PLWHA

To implement these HIV-related palliative care and HBC activities, VU/FGH will recruit the following

technical staff:

• Palliative Care/HBC Technical Advisor

• Palliative Care/HBC Coordinator

• Integrated Care and Support Supervisor

Scale up TB/HIV collaborative activities; (a) implementation of TB infection control measures in health

facilities; (b) training; (c) M & E and supervision; (d)Support the secondment of a provincial TB/HIV

technical adviso; (e) Strengthen the referral syVanderbilt U./Friends in Global Health (VU/FGH) is currently

providing adult and pediatric HIV Care and ART treatment services in 4 districts in Zambézia Province with

expansion planned in 3 more districts. Treatment site expansion will continue to support on-going work in 6

currently supported sites within 4 districts and expand to include 4 sites in each district (24 sites in 6

districts) plus the addition of 4 mobile clinics (1 each in 4 districts).

As part of the comprehensive HIV care and treatment services VU/FGH will implement the following

activities:

1) Prioritize and create linkages between existing TB program activities and VU supported adult/pediatric

ART treatment activities, including HIV testing programs (i.e. VCT, PMTCT, and antenatal clinics).

2) Establish appropriate screening, diagnosis, referral for treatment and follow-up for TB within all ART

treatment programs including PMTCT.

3) Establish linkages with existing TB programs and support HIV testing for TB patients.

4) Support relevant TB laboratory and diagnostic service capacity

5) Implement Isoniazid preventive therapy (when active TB has been ruled out amog HIV+ patients) in

VU/FGH supported health facilities.

6) Implement TB infection control measures in all VU/FGH supported health facilities.

VU/FGH will provide support for infrastructure development, staffing, clinical supervision and mentoring,

training, adherence and psychosocial support, monitoring and evaluation, and TB/HIV community outreach

activities.

Finally, for policy and technical support, these funds will be used to support the secondment of a provincial

TB/HIV technical advisor who will work with the provincial Coordinator for TB/HIV/malaria on TB/HIV

program managment in Zambezia province (provincial focus) .

Objective 1: Increase output (numbers) and quality of trained allied health personnel in the Province.

Objective 2: Increase provincial capacity to support and expand clinical laboratory services for AIDS care

and treatment.

Objective 3: Increase country capacity to support and expand AIDS prevention, care and treatment

research activities.

Targets:

• Basic training for allied health personnel (nurses, medical technicians, pharmacists, and lab technicians)

for at least 180 new professionals in Zambezia.

• Improvement in the continuing education training program for lab technicians having an impact on the

training of at least 40 laboratorians in Zambezia.

• Improvement of the continuing education program in Zambezia, which will benefit directly at least 95 HC

workers.

Activities:

• Support the basic training of health care personnel at Zambezia Institute of Health Science (Instituto de

Ciencia de Saude Quelimane -ICSQ). We propose to support 6 pre-service training courses (mid-level) for

medical technologists, general nurses, MCH nurses, pharmacists, and laboratorians.

• Support the continuing education program of the Zambezia Provincial Health Directorate by improving the

capacity of the continuing education for health professionals in the following areas: Creation of a computer

training room, installation of a digital library, financial and technical support of key trainings, and

infrastructure support.

• Support the creation of a laboratorian training course at the Quelimane Institute of Health Science

(Instituto de Ciencia de Saude -ICSQ). There is currently no laboratorian course offered there, and VU

would propose to establish a partnership with ICSQ to implement needed infrastructure improvements in

Quelimane and recruitment of teaching staff. The laboratory at Quelimane Provincial Hospital would serve

as training ground for laboratorians in training.

• Support the creation and implementation of a system of sample and information transport from primary

care units, to districts to province and back for the different diagnostic and confirmatory tests required for

the appropriate care and treatment of HIV patients, including HIV testing, TB testing, STIs and opportunistic

infections. Federal Express, a TN based company may be a potential partner to support this effort making

use of its tremendous inventory control and shipping experience.

• Support the secondment of a technical advisor to the DPS Zambezia for coordination, improvement and

expansion of diagnostic and reference laboratory activities related to clinical management of HIV care and

treatment

• Support a national collaboration with Eduardo Mondlane University (Department of Community Medicine,

and Department of Anthropology), MISAU's National Institute of Health, and the newly created Ministry of

Science and Technology for Public health evaluation training on HIV/AIDS. This collaboration would provide

added benefit to Mozambique with little additional cost for developing training materials. These activities

include in-country, short term training and mentoring, medium term regional training, and scholarships for

long-term training outside Mozambique, in collaboration with other institutions. Current partnerships that

make VU uniquely suited for this include: The Fogarty International Center (FIC)-National Institutes of

Health (NIH) sponsored Vanderbilt-Meharry Framework Program in Global Health, the Fogarty International

Clinical Research Scholars (FICRS) program (partnership with the Association of American Medical

Colleges - http://www.aamc.org/students/medstudents/overseasfellowship/start.htm), and the AIDS

International Training and Research Program (AITRP) supported by FIC-NIH, with a special Zambia

supplement for in-country PHE and operations research training from PEPFAR through CDC. In addition,

VU has discussed potential collaborations for such trainings with several Universities. For example, the

University of Melbourne -UM (Australia) and the University of Cape Town (S.A.) have agreements with VU

for training and research collaboration, and University of Maryland has historically trained many

Mozambican professionals in areas spanning from Agronomy to Public Health. Similar collaborative

opportunities exist with several US based Universities.

Activities:

• Continue support to the Province Health Directorate for planning, scaling up and monitoring ARV program

implementation through technical assistance.

• Expand support and oversight of comprehensive care and treatment services to a total 3 health units in

addition to the district hospital.

• Create and support 4 mobile clinics that will provide care and treatment services in 4 districts in areas

where the population does not have access to health care.

• Continue and expand implementation of HIV/Qual quality measurement and improvement system in all

sites in 6 districts.

• Improve early diagnosis of Neonatal and Pediatric HIV infection at existing treatment sites linking all

access points for entry into care: PMTCT, neonatal wards, in-patient wards, well child clinics/EPI

• Continue and expand comprehensive care and ARV services to HIV-infected infants and children including

OI management, early access to routine immunization programs, early identification and management of

malnutrition, malaria/TB/diarrhea prevention.

• Continue and expand comprehensive pediatric care for HIV-exposed non-infected infants while at risk due

to maternal breast feeding including well child care, malaria/TB/diarrhea prevention, nutrition education and

monitoring of HIV status.

• Expand community-based NGOs partnerships to strengthen community care linkages in Zambézia

Province. Agreements are currently being negotiated with World Vision (WV) and Medical Service

Corporation International (MSCI). Program areas will include home based care, community education,

adherence and PLWHA support.

• Engage communities in VCT, PMTCT, care and treatment efforts in the rural catchment areas of our

projects, through community outreach, community theater, houses of worship, womens' organizations,

schools, and tribal leaders through CBOs.

• Continue to expand and support the electronic medical record system that will be established in

collaboration with MISAU and the DPS.

• Continue to support and expand community outreach programs aimed at increasing community and

patient education about care and treatment, encouraging patients to adhere to medication through

understanding of treatment, follow up on visits, etc. This will include the set up of active case finding and

management teams, which in collaboration with CBOs will ensure appropriate follow up of patients and

Activity Narrative: continuum of care.

• Evaluate patient flow at each district and subordinated primary care clinic to improve referral, follow up and

integration of services. This will include innovations on transportation / mobile clinics to increase coverage

of health services as well, as increase community participation.

• Installation of containers to be used as additional storage facilities at the provincial level for care and

treatment medications in support of the provincial drug warehouse.

• Installation of information system and IT connectivity to manage warehousing and distribution of health

supplies and medicines in a timely and reliable fashion.

April08 Reprogramming change: Support integration of M&E into MPH Program at Eduardo Mondlane

University ($100,000 - $50k TBD SI and 50K CDC OHPS)

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.