Continuing Activity - Replacement Narrative:

This activity is a continuation of South-to-South collaboration with Brazilian experts to support and provide

short-term technical assistance (TA) to the Mozambican National Prevention of Mother-to-Child

Transmission (PMTCT) program.

In collaboration with the MOH PMTCT technical program staff, a Brazilian consultant was contracted

through this mechanism to provide technical assistance for the development of CT training modules to

become part of the existing National PMTCT training curriculum in FY06 and FY07. By the end of FY07, the

new PMTCT-CT module is expected to be complete, and MOH support for a pilot soon after has already

been established. In addition, the consultant assisted with identification of other parts of the PMTCT

curriculum that relate to counseling on issues beyond HIV pre/post-test counseling and testing (e.g. nutrition

counseling) and a review of all counseling sections throughout the PMTCT training manuals.

Building on this foundation, comprehensive review of the national PMTCT training manual will be

undertaken in FY08, including technical guidance on PMTCT regimens and clinical staging. The ultimate

goal of this activity is to produce a revised and updated PMTCT training manual for use in Mozambique.

This activity will support the contracting of a Brazilian expert for TA visits in FY08 to accompany and assist

with the revision of the PMTCT training manual.

This activity will support technical assistance (TA) provided to the Ministry of Health (MOH) STI/HIV

program by a Brazilian specialist for finalization of sexual abuse algorithms and facilitation of a

dissemination workshop; review of STI training materials and algorithms for Anti-Retroviral Treatment (ART)

settings as well as Prevention of Mother-To-Child (PMTCT)/Antenatal Care (ANC) services.

This activity is aimed at supporting TA from a Brazilian expert to the MOH STI/HIV program for:

(a) Finalization of the development of an algorithm on sexual abuse in children, and performance of a

dissemination and advocacy workshop. Sexual abuse of children is an important problem among families,

where family members, friends, teachers, and others are often identified as the abuse perpetuators

therefore creating an environment facilitating repeated abuse and psychosocial problems for the victims. To

-date the MOH STI/HIV program has developed an algorithm addressing sexual abuse in adults. Funding

under this activity will support the finalization and dissemination of an algorithm for sexual abuse in children.

Existing algorithms for sexual abuse tend to mainly address clinical management of victims and lack other

aspects such as reference to and management of psychosocial and other aspects arising from the abuse.

TA from a Brazilian specialist will assist the MOH and its stakeholders to develop a more comprehensive

algorithm addressing all needs of abused children. The specialist will also assist with facilitation of a

workshop that will serve to disseminate the algorithm and advocate with different stakeholders, including

staff from other line ministries on the need for a comprehensive approach and services for victims of sexual

abuse.

(b) Revision and adaptation of guidelines, training materials, and job aids on management of STIs for HIV-

infected patients and their partners, attending ART and ANC/PMTCT services: This activity will build on the

results of the assessment of STI diagnosis and treatment in ART settings supported by USG FY06/07

funds. The assessment provides information on the prevalence of STIs in HIV-infected patients followed at

ART service sites and integration of STI prevention, diagnosis, and treatment in routine outpatient HIV care

and treatment settings.

TA from the Brazilian specialist, with experience in the development of clinical guidelines and training

materials for Mozambique, will assist the MOH STI/HIV program staff to develop and pilot technically sound

materials.

Continuing Activity: The Federal University of Rio de Janeiro (FURJ) has been providing technical

assistance (TA) for the Mozambican Counseling and Testing (CT) Program since FY05. Main focus of

activities has been the strengthening of CT program training and monitoring through the development and

improvement of CT training materials and supervision tools. This activity is a continuation of South-to-South

collaboration with Brazilian experts to support and provide short-term technical assistance (TA) to the

Mozambican National Counseling and Testing Program.

This activity will support TA provided by Brazilian HIV/AIDS, CT and training experts to assist the MOH CT

Program and technical staff to improve existing national CT guidelines, revise training materials as well as

support its piloting, to reflect the new CT directions taken by the MOH: 1) the Counseling and Testing in

Health (CTH) approach, which integrates the HIV testing with TB, Sexual Transmitted Diseases (STD) and

hypertension screenings and referral when needed, as well as with counseling on malaria prevention,

Sexual and Reproductive Health orientation - especially in relation to early pregnancy diagnosis and

institutional delivery - and environmental health education; and 2) the expansion of Provider Initiated CT

(PICT) in clinical settings.

In FY08, FURJ will continue to provide TA support to the CT program. Activities planned are:

1. Support a full-time Brazilian CT expert as well as short-term consultants for CT training, laboratory and

M&E related activities.

2. Support CT material development and revision, piloting of new materials, co-facilitation of trainings;

2. Translation and adaptation of couples counseling and testing materials addressing issues of disclosure

and discordance, as well as transition towards family focused CT services and;

3. Support the operationalization of the HIV rapid testing training package: The generic training materials

have been translated using FY07 USG funds. FY08 funds will permit training of approximately 100

laboratory personnel and CT providers using the new and improved HIV testing materials.

April08 Reprogramming Change: Increase in funding by $50,000 for training.

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.

Continuing activity: This activity has several different components of continuing and new activities with

emphasis on in-service and pre-service training. The Federal University of Rio de Janeiro is supporting the

Ministry of health in its efforts to build the capacity of Laboratory technicians within the lab network. In FY08

FURJ will implement the following activities.

1 - Continuation of technical training for Mozambican Lab Technicians in Brazil

This training will provide a four month technical/practical training in immunology, biochemistry, hematology,

as well as laboratory and quality management training for 15 (superior and medium level) Mozambican Lab

technicians in Brazil.

2 - Continuation of TA for the PT program

FURJ will continue to support the National Institute of Health Immunology lab (NIH) to maintain and expand

the national proficiency testing program for HIV serology to include sending out of dry plasma spots for

remote laboratories performing HIV rapid tests and to introduce a PT program for HBsAg TA. In addition TA

will also be provided to the NIH to in its efforts to become the MOH reference laboratory for serology in the

country

3 - Continuation of TA for the implementation of Quality Systems and a Bio-safety program at the NIH. This

will include supervision visits to maintain both programs

4 - Continuation of the In Country Project Manager (ICPM)

One Brazilian laboratory professional will be stationed in Mozambique as the ICPM and a second recruited.

They responsibilities will include: preparation of training courses and technical material for lab staff,

supervision visits to laboratories, as well as planning of continued education activities for lab network. They

will also ensure collaboration between FURJ/FUJB, CDC-Mozambique and the MOH.

5 - Continuation of Mentorship training program in laboratories performing CD4 lymphocyte count by flow

cytometry, biochemical and hematological tests. Three trainings for a period of 9 months will be conducted

with 25 people trained and laboratories that received this training in COP'07 will receive supervision visits to

support the maintenance of good laboratory practice.

7 - To provide three faculty to teach courses for the superior level laboratory technicians, for a period of one

year. The aim of this activity is to assist the MOH increase the critical mass of well trained professionals.

Teachers will follow curriculum developed by the MOH and Mozambican teaching institutions and 30 people

will be trained.

8 - Conduct a workshop to promote collaboration between clinicians and laboratorians.

9 - Provide TA to the TB reference laboratories in Mozambique to implement TB culture diagnostics and

DST in the regional labs in Beira, Maputo and Nampula.

10 - Develop curriculum for a course to upgrade the medium level technicians to superior level.

11- Support a position within the MOH Laboratory section, to build capacity of the department in strategic

program planning and implementation.

FY07:

This activity is related to activities 8632, 8546 and 8581 and contributes to the strengthening of the

laboratory network in Mozambique.

There are several components to this activity which include:

1) Train laboratory technicians and scientist in standard lab practice in the field of hematology, biochemistry,

CD4 testing and microbiology.

2) Develop and implement a training and mentorship program for laboratory technicians in all provincial and

district hospital laboratories that have been rehabilitated and provided with laboratory equipment through

efforts of other Emergency plan funded partners. This component will support training of 60 laboratory

technicians from all provinces in the country.

3) Develop and disseminate standard laboratory operating procedures for hematology, biochemistry, CD4

and immunology and definition of services to be offered at the various levels of laboratories in the health

system.

4) Continue providing technical assistance to the Immunology department at the INS in the Quality

Assurance program for HIV Serology.

5) Develop infant laboratory testing algorithms and pilot DBS testing: This activity will support travel and

technical assistance (TA) provided by a Brazilian Laboratory expert. In FY06 the laboratory expert has

helped the MOH NIH, PMTCT and pediatric treatment staff to develop the algorithm for infant testing for

Mozambique, using Dried Blood Spot (DBS) samples for PCR laboratory diagnosis. The Brazilian expert

helped to train Mozambican laboratory staff on the use of the first PCR machine installed in Mozambique at

the NIH laboratory and conducted a first training for pediatricians on DBS