PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
This is a new activity.
The new Combination Prevention Indefinite Quantity Contract (IQC) is aimed primarily at General
Population adults and secondarily, at Mobile and Bridge populations and people living with HIV (PLH). A
Youth component will begin in Year Two through COP 2010 funds (see note on Youth below). This IQC
also receives CT funding for community or site based Counseling and testing. This activity is
geographically focused on the high prevalence provinces of Maputo city, Maputo and Gaza and in hot spots
and corridors identified by the 2008 Mozambique Data Triangulation (Beira, Nacala, Niassa corridors;
Pemba, Quelimane, Mabote). Key drivers to be targeted in this new program include mulitple and
concurrent partnerships (MCP), low condom use, low knowledge of sero-status/low uptake of CT, low risk
perception, weak individual locus of control, sero-discordancy, low male circumcision in targeted geographic
areas, alchohol abuse, and social and gender-based norms that increase risk and vulnerability.
Components of the new IQC for Combination Prevention will work in an integrated and multi-layered
approach to reach General Population Adults at the individual, couple, family, institutional, community,
social and political level. AB funded activities will include behavioral and structural interventions and will
promote services funded under other program areas such as C&OP, CIRC or Care for Community-based
Positive Prevention. Behavioral activities will include national, local and folk media through mulitple
channels of communication. Large mass media activities will follow guidelines set forth by the National HIV
Communication Strategy and, for MCP, the MCP Communications Strategy. All messages and campaigns
will be vetted through the Partners' technical working group (TWG) for Communications and the USG
Prevention TWG to ensure coordination and reinforcement with USG and non-USG funded on-the-ground ,
interpersonal (IPC) behavior change communication activities (BCC).
All on-the ground IPC BCC and community mobilization programs will go beyond building basic awareness
and will focus on building risk perception to change individual behavior and risky social norms. Alcohol
abuse will be addressed, especially in IPC BCC targeting men, for example, in work place based programs.
AB funds for the new IQC will also promote linkages to clinical health services that are funded under other
program areas, such as counseling and testing, STI screening and diagnosis, ART, family planning and
reproductive health, and when policy allows, surgical male circumcision. AB funds may also be used to
create IEC about the limitations of CIRC to address possible risk compensation, as part of a
comprehensive CIRC program. Awardee/s of this IQC will be required to have a strong technical and
organizational capacity building component with 'graduation plans' for Mozambican sub-partner
organizations to eventually seek their own funding as prime partners to USG or other donor funding.
New activities aimed at Mobile and Bridge populations and PLH are split funded between AB and C&OP
funds and are split funded between the IQC for Combination Prevention and the IQC for MARPs.
Mobile/Bridge population activities under both IQCs will be institution and peer-based interventions that
include risk reduction counseling (individuals and peer-based), venue based outreach, individual.peer-
based communication materials and will also address alcohol. Through care funding, activities for
mobile/bridge populations will also receive mobile or site based counseling and testing services and through
C&OP funds, STI screening and treatment and targeted condom distribution. When policy allows, CIRC
funds will provide MC services for men in these populations. AB funded activities for community-based
Positive Prevention (PP) for PLH include advocacy media linked to on-the-ground community activities to
reduce stigma and discrimination,addressing alcohol, disclosure, and risk reduction and through Care funds
for the two new IQCs, community based CT. These commnity-based PP interventions will complement and
be integrated with clinic-based PP components funded through C&OP and care include STI screening and
treatment, FP, Tx adherence, condoms, FP, and facility-based couple and family CT.
*Youth-focused programs will not begin until Year Two (COP 2010) as existing Track 1 ABY programs are
operating in the geographic areas of consideration until June 2010. . Future youth program under this new
IQC will be aimed at 10-19 year olds and will be comprised of media, community mobilization and adult-led,
peer-based IPC BCC. School-based, and for out-of-school youth, community-based, small group activities
will use the adult-led, peer-based approach with a life/skills based curriculum coordinated with messages of
large media activities for youth. AB funded youth activities will promote youth-friendly services funded
under other program areas, such as youth friendly CT, PMTCT and FP, other HIV care and treatment
services.
$200,000 of AB funds under this activity are earmarked for a legal or policy-focused organization to build
capacity of the Ministry of Education and Culture (MINEC) at the central but primarily at the provincial and
district levels, to enforce existing policies against sexual abuse in schools, i.e., to address 'sexually-
transmitted grades' or 'sex for grades'. Priority area for this activity is the Southern region and Sofala
province. This legal/policy activity is linked to the legal/policy activity in the Care IQC that addresses
inheritance rights for OVCs. The awardees of this and the Care IQC will be directed to work together to
identify one (1) legal/policy organization to implement both programs.
*Project and impact evaluation of this activity will be funded through a separate SI activity.
-Justification
Activity created during prevention portfolio reorganization per PEPFAR Mozambique prevention strategy.
Targets are for nine-months of implementation as start up is anticipated for quarter 2 of FY2010.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.02:
The new MARPs Indefinite Quantity Contract (IQC) is aimed primarily at Commercial Sex Workers (CSW)
and secondarily at Mobile and Bridge populations . The latter include groups such as clients of CSW;
miners; long distance drivers; uniformed services; migration/border officials; incarcerated populations;
'mukheristas', informal female traders at the border; and partners and families of these populations. This
IQC also receives CT funding for community or site based Counseling and testing. This activity is
Pemba, Quelimane, Mabote). While a MARP size estimation and mapping has not yet taken place in
Mozambique, preliminary findings from the CSW and IDU I-RARE study, as well as analysis from the 2008
Data triangulation, have identified key hot spots. Activities under this IQC will target these areas and hot
spots. Key drivers to be targeted include low risk perception, low condom use, low knowledge of sero-
status/low uptake of CT, multiple and concurrent partnerships (MCP), sero-discordancy, low male
circumcision in targeted geographic areas, alchohol abuse, and social and gender-based norms that
increase risk and vulnerability.
Components of the MARP IQC will work in a comprehensive and site-based approach to reach CSWs and
Mobile/Bridge at the individual, couple, family, institutional, community, social and political level. This
activity will build upon and replicate the successful Maputo port night clinic for CSWs and their clients, a
‘one-stop shop' site offering peer-based outreach, small group risk reduction BCC, condom distribution and
negotiation skills building, CT, STI screening and treatment and ART referrals. The new awardee will be
encouraged to establish other night clinics in key hot spots in urban centers and major corridor cross roads
Other C&OP funded activities under the new MARPs IQC will include behavioral (peer-based risk
reduction, targeted condom distribution); some bio-medical (STI screening and treatment) and structural
interventions. Additional services funded under other program areas such as CIRC for male circumcision
for mobile men, or Care for mobile CT. Behavioral activities will include peer-based IPC BCC, advocacy
and sub-population-appropriate IEC. All sub-population messages and campaigns will be vetted through
the Partners' MARP technical working group (TWG) and the USG Prevention TWG to ensure coordination
and reinforcement with USG and non-USG funded on-the-ground , interpersonal (IPC), peer-based, risk
reduction activities.
New activities aimed at Mobile and Bridge populations are split funded between AB and C&OP funds and
are split funded between the IQC for Combination Prevention and the IQC for MARPs. Mobile/Bridge
population activities under both IQCs will be institution and peer-based interventions that include risk
reduction counseling (individuals and peer-based), venue based outreach, individual.peer-based
communication materials and will also address alcohol. In addition to the activities stated above, C&OP
funds for the MARP IQC will also promote linkages to clinical health services that are funded under other
program areas, such as counseling and testing, ART, family planning and reproductive health, and when
policy allows, surgical male circumcision. Mobile pop activities will receive AB funds to address partner
reduction components of a risk reduction program. When policy allows, CIRC funds will provide MC
services for mobile men. AB funds may also be used to create IEC about the limitations of CIRC to address
possible risk compensation, as part of a comprehensive CIRC program.
All peer based and small group BCC programs will go beyond building basic awareness and will strengthen
individual risk perception and locus of control. Alcohol abuse as a risky behavior among each of the sub-
pops will be addressed, for example, in work place based programs for migration officials or police recruits.
Awardee/s of this IQC will be required to have a strong technical and organizational capacity building
component and 'graduation' plan for Mozambican sub-partner organizations providing services to these
populations. Awardees will be strongly encouraged to take on CSW or mobile pop led community based
organizations as sub-partners for capacity building in advocacy and prevention implementation.
*Project and impact evaluation of this activity will be funded through a separate activity under SI.
Table 3.3.03:
Population adults and secondarily, at Mobile and Bridge populations and people living with HIV (PLH).
These funds provide some condom and other prevention activities to General Pop adults, the primary target
group of the Combination prevention activity, and PLH. More condom funding for Mobile and Bridge
populations is provided under the new MARP activity. This IQC also receives CT funding for community
or site based Counseling and testing. This activity is geographically focused on the high prevalence
provinces of Maputo city, Maputo and Gaza and in hot spots and corridors identified by the 2008
Mozambique Data Triangulation (Beira, Nacala, Niassa corridors; Pemba, Quelimane, Mabote). Key
drivers to be targeted in this new program include mulitple and concurrent partnerships (MCP), low condom
use, low knowledge of sero-status/low uptake of CT, low risk perception, weak individual locus of control,
sero-discordancy, low male circumcision in targeted geographic areas, alchohol abuse, and social and
gender-based norms that increase risk and vulnerability. Components of the new IQC for Combination
Prevention will work in an integrated and multi-layered approach to reach General Population Adults at the
individual, couple, family, institutional, community, social and political level. C&OP funded activities will
prioritize mobile/bridge and PLH populations and will complement partner reduction focused activities as
appropriate. Condom promotion, distribution are funded here and will complement AB supported partner
reduction programs; CIRC when available or Care for Community-based Positive Prevention.
organizations to eventually seek their own funding as prime partners to USG or other donor funding. These
C&OP funds will provide complementary programs for condom use, negotiation and distribution.
Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety
Total Planned Funding for Program Budget Code: $2,370,000
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
HMBL - Blood Safety
A total of 140 Blood Banks (BBs) currently provide blood transfusion services at health facilities in Mozambique. Coverage is
limited to the same extent as access to health facility-based services in Mozambique (40-50%), with many remote and rural areas
having limited or no access to health services.
To date, other donor and partner agencies have taken only limited interest in blood safety. Outside of USG support, the National
Blood Transfusion Program (NBTP) receives some funds allocated by the Ministry of Health (MOH) to the NBTP, mainly for
procurement of BB equipment and reagents. Advocacy with other donors and stakeholders is greatly needed to raise awareness
about the importance of the blood transfusion services, and prevention of medical transmission of HIV and other blood borne
diseases. The American Association of Blood Banks (AABB) is the USG-funded NBTP technical assistance (TA) provider,
supporting the program in the effort to improve blood safety and transfusion services in Mozambique.
USG support has directly contributed to improvements and progress of the NBTP progress to date: the number of blood units
collected increased from 57,800 in 2003 to 79,925 in 2007. In 2007, around 56% of blood donations came from voluntary non-
remunerated blood donors while around 44% came from replacement or family blood donors.
In 2007, MOH NBTP reported that 100% of blood units at all BBs were screened for HIV, hepatitis B and syphilis. HIV prevalence
in blood donors increased from 6.4% in 2005 to 8.1% in 2006 but decreased to 7.2% in 2007. Syphilis prevalence in blood donors
decreased from 3.7% in 2004 to 2.9% in 2007. Screening of blood units for Hepatitis B was introduced at the end of 2004, and
HBV prevalence in blood donors decreased from 7.6% in 2005 to 6.5% in 2006 and further decreased to 5.4% in 2007. Currently,
HIV counseling is not performed at BBs in Mozambique but plans are in place to implement counseling with the help from the
MoH prevention program. Systematic screening of donated blood at four central level BBs (Maputo, Beira, Nampula and Jose
Macamo General Hospital) uses laboratory-based ELISA for HIV and Hepatitis B, and RPR for syphilis. Peripheral BB screening
uses HIV and HBV rapid tests, and RPR. Plans for Fiscal Year 2009 (FY09) include the introduction of Hepatitis C screening. Also
in FY09 all provincial BBs will be transitioning from HIV rapid testing to HIV ELISA test. Advantages of ELISA over Rapid Tests
are: a) increased daily testing capacity; b) increased sensitivity and thus increased confidence in provision of safe blood; and c)
better standardized testing operation, including the use of internal and external controls.
During the first year of USG support, AABB provided TA to the NBTP for the development of a National Blood Transfusion Policy
and facilitated the development of blood safety norms and standards which serve as the foundation of a quality assurance (QA)
system for blood transfusion services in Mozambique. AABB supports an ongoing revision of Standard Operation Procedures and
has incorporated QA into training activities since 2007.
With TA provided by AABB, the NBTP has proposed a re-organization of the NBTP including a transition to a network model of
service provision. In 2005, the MOH started the re-organization with 27 BBs (2-3 per province) upgraded to become reference
units for 83 smaller BBs. Centralized collection and testing is more cost-effective, optimizes equipment maintenance, utilizes best
available trained personnel, and is easier to harmonize and coordinate activities across the country. While reference BBs will
conduct a full range of procedures—blood collection, testing, production of blood components, storage, and administration of
blood units—they will also be responsible to supply smaller BBs and health facilities with blood units. Since 2005, USG funds
have supported the upgrade of 10 of the 27 reference BBs, and rehabilitation of the regional BB of Nampula Central Hospital (3rd
largest hospital in Mozambique) and the BB of Chimoio Provincial Hospital in Manica Province. The 83 smaller BBs will be divided
into two groups: those performing collection, testing, and administration of blood units, and those storing and administering blood
units only. For FY09, all 10 provincial BBs will be visited and recommendations for renovations, equipments acquisition and other
needs (including training and improved workflow of activities) will be issued. It is expected that at least 3 to 5 such BBs will need
some level of physical rehabilitation.
As the new national blood transfusion regulations, developed in 2006, are in final stages of MOH approval, the Minister of Health
decided, in line with international WHO guidelines, to establish an independent national blood transfusion service. USG FY07 and
FY08 funding has assisted the MOH, through RPSO, to design and construct a new facility which will bring the Blood Transfusion
Services Directorate and the National Referral BB together under one unit. The establishment of this unit aims to improve the
coordination of services between these two bodies, establish an improved National blood safety training facility, and strengthen
the coordination of the National Blood Transfusion Quality Assurance and M&E.
To build human capacity, AABB technical experts facilitated the development of training materials for blood donor services, donor
evaluation and infectious disease testing (IDT). To date, 51 BB staff from across the country have been trained. To build
sustainability, training of trainers (ToT) materials have been implemented. In March 2008, two donor evaluation trainings were
given by the Mozambican trainers; a ToT for IDT took place in April 2008 for seven individuals; and at least one more IDT training
is planned for 2008. With FY09 funds, ToT training materials will be developed for immunohematology, blood processing,
phlebotomy, donor notification, and blood collection through mobile units. A total of 95 NBTP staff (including 15 Mozambican
trainers), from all 10 provincial BBs will be trained. To further improve the recruitment of safer blood donors, the NBTS is training
previously hired blood donor mobilizers to target safer donor populations such as younger donors at secondary school. This effort
aims to create a "Clube 25" similar to the Zimbabwean "Club 25", shown to be an effective strategy to increase younger, low-risk
blood donors. Capacity building through mentoring will continue in FY09. In August 2008, mentors were placed in Beira and
Nampula Provincial BBs for 3 months to focus on improving IDT, operational design, quality control and the work flow in the BBs
and four additional mentors are planned for provincial BBs in FY09.
MOH and AABB staff have initiated activities to improve monitoring and evaluation (M&E) within the NBTP. New data collection
forms for blood transfusion service M&E were piloted at selected BBs, with national implementation planned for FY09. In 2008,
an assessment of existing BB computer systems was done and will be examined to determine feasibility of a computerized data
system across the BB network. Related activities will include recruitment and training of Mozambican IT staff to manage and
maintain the data base and BB monitoring system.
HMIN - Injection Safety (IS)
The goal of the IS program is to reduce the risk of transmission of HIV, TB, and other blood borne pathogens (e.g. Hepatitis B and
C) at health facilities throughout Mozambique where HIV services are supported by USG. IS programming is administered by the
MOH Directorate for Medical Assistance, and closely linked to the National Nursing Department through the National Infection
Prevention and Control (IPC) Task Force. The National IPC Task Force, chaired by the MOH, provides leadership for IPC
activities. IPC staff coordinate, supervise, and implement all IPC activities, including IS.
USG funds have supported two complementary TA and implementation partners since 2004. These partners actively participate
in the IPC Task Force and provide broad TA to the IPC program for implementation of IPC activities at hospital level. MOH, with
technical assistance from USG partners, has been implementing a nationwide Standards-Based Management and Recognition
approach (SBM-R) to improve IPC practice from 2004-2008 in major USG supported hospitals providing ART services and
serving as referral units for HIV/AIDS services throughout the country. Using the SBM-R approach, health staff across different
services areas including ART, PMTCT, CT, laboratories, and blood banks identify and correct IPC activities to increase safety and
prevent HIV transmission for both patients and health providers. The program has been expanded from 6 hospitals in 2004 to 43
hospitals in 2008.
Additionally, USG partners have provided TA and support to improve waste management systems since 2006, including
procurement and installation of hospital incinerators and training and supervision of waste separation and safe disposal, in
particular for ART sites with larger number of patients and thus large amounts of contaminated waste. In 2008, a total of six
hospitals have improved their waste management system and health staff have already been trained and supervised on the
operation and maintenance of the system.
In 2009, the objective is to continue to support the MOH efforts in further consolidation of the IPC program and expansion to a
total of 53 hospitals; a total of eight hospitals will improve their waste management system throughout the country. FY09 funding
will support DNAM and the National Nursing Department of the MOH to roll out training to health workers of health units where
there are no partners. This enhances the MOH staff's capacity to utilize training materials developed with assistance from USG
partners, and to implement activities on their own, strengthening their confidence and implementation experience in the absence
of outside support, which in turn will contribute to long-term sustainability and continuation of the program activities.
All USG-funded partners will prioritize medical transmission prevention activities in the three PEPFAR focus provinces, Sofala,
Zambezia, and Nampula, for the selection of new sites, staff training, and resource allocation of personal protective equipment.
CIRC - Male Circumcision
Randomized, controlled trials have confirmed that male circumcision (MC) reduces the likelihood of female to male HIV
transmission by approximately 60%. Safe MC services require well-trained healthcare providers, appropriate infection prevention
and control practices, and sufficient equipment and supplies. In addition to the surgical procedure, other essential elements of MC
services that must be taken into account include informed consent, post-operative care and risk reduction counseling including
partner reduction and a minimum package of male reproductive health services, such as sexually transmitted infections (STI)
treatment, condom distribution, and HIV counseling and testing.
In Mozambique, approximately 60% of men are circumcised; highest rates are in the provinces of Niassa, Cabo Delgado,
Nampula, and Inhambane. MC is somewhat more common in urban areas, compared with rural (62% vs 57%), and there are
strong correlations with religion (e.g. 93% of male Zionists are circumcised). The average age of MC in Mozambique is 10 years.
Since late 2006, USG partners have been funded to provide technical guidance to the MOH and the National AIDS Council (NAC)
to plan and prepare a situational assessment (now nearing final stages of data analysis) to identify the MOH capacity for
expanding safe MC services for prevention of HIV transmission. Activities in FY09 will build upon the current work and the results
of the situational assessment. USG and partners will work with the MOH to develop new policy, services, and prevention
messages for MC. Objectives will be to work with the MOH to develop a comprehensive program that is consistent with the
Mozambique context.
Activities proposed for continuation also include capacity building and advocacy with the MOH, the NAC, and stakeholders in the
area of MC. The proposed funding will support a series of workshops and capacity building events that will assist to (a)
continuously update government staff and stakeholders on progress of MC activities in-country as well as
internationally/regionally; (b) ensure that data from the assessment are shared with all relevant government entities and
stakeholders, and that a participatory process is in place to ensure a constructive debate around the results, recommendations
and joint planning for the development of the intervention plan and package; (c) support translation of key MC documents to
Portuguese; and (d) support the in-country MC working group, chaired by MOH staff, with participation from NAC and other
stakeholders (including WHO, UNAIDS, UNICEF, and USG and its partners) as needed. Military populations will continue to be a
prioritized target for MC services.
At the time of COP submission, Mozambique MOH policies do not support expanded MC activities. This is largely attributed to
severe constraints on the health system, and specifically surgical capacity in Mozambique, due to limited human capacity,
infrastructure, and other resources. It is possible that until emergent and life-saving surgical capacity is expanded, MC surgical
capacity may remain under-developed. With more evidence circulating in the literature and greater regional experience, however,
the MOH may review its current position on MC and more aggressively support access to safe and affordable surgical services in
the near future. Until this is realized, the relatively small-scale USG approach described above will continue, with attention to
positioning USG to be able to rapidly scale up when the policy environment becomes more favorable.
Table 3.3.04:
also receives AB and C& OP funding for behavioral and structural interventions and will promote services
funded under other program areas such as C&OP, CIRC or Care for Community-based Positive Prevention.
This activity is geographically focused on the high prevalence provinces of Maputo city, Maputo and Gaza
and in hot spots and corridors identified by the 2008 Mozambique Data Triangulation (Beira, Nacala, Niassa
corridors; Pemba, Quelimane, Mabote). Key drivers to be targeted in this new program include multiple
and concurrent partnerships (MCP), low condom use, low knowledge of sero-status/low uptake of CT, low
risk perception, weak individual locus of control, sero-discordancy, low male circumcision in targeted
geographic areas, alchohol abuse, and social and gender-based norms that increase risk and vulnerability.
social and political level. Behavioral activities will include national, local and folk media through mulitple
Behavioral and structural ctivities aimed at Mobile and Bridge populations and PLH are split funded
between AB and C&OP funds and are split funded between the IQC for Combination Prevention and the
IQC for MARPs. Mobile/Bridge population activities under both IQCs will be institution and peer-based
interventions that include risk reduction counseling (individuals and peer-based), venue based outreach,
individual.peer-based communication materials and will also address alcohol. and through C&OP funds,
STI screening and treatment and targeted condom distribution. When policy allows, CIRC funds will provide
MC services for men in these populations. AB funded activities for community-based Positive Prevention
(PP) for PLH include advocacy media linked to on-the-ground community activities to reduce stigma and
discrimination,addressing alcohol, disclosure, and risk reduction and through Care funds for the two new
IQCs, community based CT. These commnity-based PP interventions will complement and be integrated
with clinic-based PP components funded through C&OP and care include STI screening and treatment, FP,
Tx adherence, condoms, FP, and facility-based couple and family CT.
This funding will support Community/site-Based and Mobile Counseling and Testing (CBCT) in the three
target provinces as well as in hot spots in urban centers and major corridor cross roads. CBCT activities in
the Combination Prevention program will be coordinated with CBCT activities currently under JHPIEGO,
Samaritan's Purse and other PEPFAR partners as well as planned CBCT activities under the TBD MARP
IQC. These CBCT activities will be in line with PEPFAR/Mozambique's Couples-Focused CT approach.
Counselors will be trained and equipped with the skills and materials necessary to help them provide both
quality sexual prevention counseling as well as couple counseling to clients. Counseling will move beyond
educational messages to tailor counseling sessions specific to the individual or couples' sexual behaviors
and risks and help them identify their risk and discuss different options in minimizing their risk. The limited,
existing CBCT programs in Mozambique rely on facility-based CT sites for commodity planning and
distribution, client record storage, and assistance with referrals. CBCT sites will be linked to a clinical
facility and will be fixed or mobile sites. There are a range of CBCT approaches that include
moblie/outreach, satellite and home-based services. CBCT sites aimed at MARPs will be satellite or
mobile sites with MARP-friendly hours of operation to increase access and uptake. Examples are night
sites near bars, aimed at CSWs and their clients, or mobile sites at major rest stops to reach long distance
truck drivers.
CBCT services under this activity will complement other partner programs and will be better placed to reach
rural populations and harder to reach groups, such as non-street CSWs, including males, clients of CSWs
and migrants. For example, CDC supports facility-based CT in Gaza and Maputo and USAID's Clinical
RFA will provide facility-based CT in Sofala, Manica, Tete and Niassa. CBCT services under this
Prevention Program will collaborate with and supplement existing and planned clinical CT services.
Following recommendations from the June 2008 CT TA team, these funds will also support the
development of one national CT guideline document that will define the minimum standards for all CT
services including defining confidentiality, consent and counseling; quality definitions of both counseling and
HIV testing; site standards; and define requirements for counseling staff. The program will employ
innovative means to increase utilization of the CT sites through community mobilization and CT promotion
campaigns. These outreach campaigns should specifically target men and couples since these groups
have not been utilizing existing services in certain regions. Referrals and linkages will also be supported in
the CBCT services in the provinces and corridors. These will include tracking referrals to CBCT and
CTH/PICT as well as to other clinical services and to community-based prevention programs for both HIV-
negative and HIV-positive clients. Quality assurance for rapid testing will also be emphasized in the CBCT
program. Basic procedural issues such as reading test results after assay is complete, ensuring that all
sites have timers, guaranteeing that refrigeration and temperature controls are in place, and not using
Activity Narrative: expired tests will be established. All counselors conducting rapid tests will be trained or retrained with the
CDC/WHO training package. Lab logbooks used for quality control will be integrated into the CBCT
services since they are essential for identifying source and quality problems (i.e. bad test kit lot, operator
error, transcription error). Counseling quality assurance will be an essential component of each CBCT
program that includes client feedback, counselor de-briefs and mystery clients who are both HIV negative
and HIV positive. Counselors need tools such as job aids to facilitate counseling and give reminder of what
should be discussed with each client.
Table 3.3.14:
