Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 3526
Country/Region: Mozambique
Year: 2009
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $4,432,736

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $108,680

ACTIVITY UNCHANGED FROM FY2008.

Proposed funding under this activity supports the salary and benefits package of the CDC PMTCT

Technical Advisor's position. The CDC PMTCT Technical Advisor works directly with the MoH HIV/AIDS

Program Directors, the Director of the Community Health Department, the Reproductive Health/PMTCT

Program Director, and PMTCT Program staff on the development and review of National PMTCT program

policies, guidelines and training materials, co-facilitates training of trainers, and provides on-the-job

mentoring to MOH PMTCT program staff.

The PMTCT Advisor also co-chairs, with the USAID CT&PMTCT CTO, the USG PMTCT Partners' working

group, that meets every two months, to exchange information and PMTCT materials developed by

individual partners, to discuss PMTCT implementation challenges encountered across partners, to develop

plans and provide recommendations as to overcome these challenges. The PMTCT Advisor facilitates

linkages between the MOH PMTCT team and the USG PMTCT implementing partners.

While the M&E Advisor is not funded through this activity, the PMTCT and M&E Advisors work together to

provide technical assistance and inputs relevant to M&E aspects of the PMTCT program, including

improvements in regards to PMTCT data compilation, analysis, and use of PMTCT data, improvement of

PMTCT M&E registers and tools.

FY07:

This activity is linked to 8588, 8605, 8617, and 8638 activity sheets.

Proposed FY07 funding in this activity will pay 100% of the salary and benefits package of the CDC PMTCT

Technical Advisor's position, which is currently vacant. This staff person will provide technical assistance

directly to Ministry of Health (MoH) PMTCT program personnel as well as assists the MoH PMTCT team

with coordination and guidance provided to USG and non-USG funded NGOs, CBOs and FBOs involved in

PMTCT interventions.

The CDC PMTCT Technical Advisor works directly with the MoH HIV/AIDS Program Directors, the Director

of the Community Health Department, the Reproductive Health/PMTCT Program Director and PMTCT

Program staff on the development and review of National PMTCT program policies, guidelines and training

materials, co-facilitates training of trainers, and provides on-the-job mentoring to MOH PMTCT program

staff.

This activity also includes funding for short-term technical assistance and travel expenditures for CDC

Atlanta PMTCT technical staff during FY07 to assist with the first National PMTCT program evaluation,

PMTCT service implementation at maternities, improvement of infant follow-up, and development of

activities for increased community and Traditional Birth Attendants' involvement.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12932

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12932 5257.08 HHS/Centers for US Centers for 6345 3526.08 GHAI_CDC_HQ $133,948

Disease Control & Disease Control

Prevention and Prevention

8630 5257.07 HHS/Centers for US Centers for 4865 3526.07 GHAI_CDC_HQ $178,047

Disease Control & Disease Control

Prevention and Prevention

5257 5257.06 HHS/Centers for US Centers for 3526 3526.06 GHAI_CDC_HQ $200,341

Disease Control & Disease Control

Prevention and Prevention

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

Funding for Biomedical Prevention: Blood Safety (HMBL): $70,000

ACTIVITY UNCHANGED FROM FY2008

Continuing activity: This activity is to support Blood Safety staff travel to attend Annual AABB Conference,

travel to visit blood transfusion services in one other country in the region (suggested: South Africa or

Kenya); in-country travel for supervision, facilitation of tarining and technical assistance to blood banks.

This activity also provides salary and benefit support to a Blood Safety Specialist within the PEPFAR-

Mozambique team to assist, strengthen, manage, and monitor the Blood Safety capacity building activities.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12933

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12933 5142.08 HHS/Centers for US Centers for 6345 3526.08 GHAI_CDC_HQ $10,000

Disease Control & Disease Control

Prevention and Prevention

8626 5142.07 HHS/Centers for US Centers for 4865 3526.07 GHAI_CDC_HQ $15,000

Disease Control & Disease Control

Prevention and Prevention

5142 5142.06 HHS/Centers for US Centers for 3526 3526.06 GHAI_CDC_HQ $71,012

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.04:

Funding for Care: Adult Care and Support (HBHC): $0

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Removed TA and salary related costs and for GAP6:

TASK 4: Removed from this activity sheet per OGAC guidance on PHEs.

This is a continuing activity from FY06 with no additional monies to be added. A no-cost extension until

March 31, 2009 is in the process of being approved. The following provides an update on remaining

activities.

TASK 1: Survey of HBC practices (completed)

FHI provided technical assistance in questionnaire revision, modified ANEMO's sub-contract and provided

the organization with technical and financial assistance for this evaluation, expanded per FHI's proposal to

include other topics related to quality of community care. In addition, FHI trained ANEMO supervisors in

data collection and data analysis. FHI and ANEMO have finalized data collection and data analysis. At

present, the first and second drafts of the survey report have been developed and submitted to CDC, and

upon approval will present findings to the MOH.

TASK 2: Create an evaluation tool for NGOs HBC Programs

For the adaptation of the NGO HBC Program Evaluation tool, FHI has initiated the process for directly hiring

a consultant to assist in the development of these tools in coordination with the HBC Technical Group at the

MOH. The consultant will lead a working group composed of representatives of four NGOs that implement

HBC to develop and/or adapt self-evaluation tools for various aspects of HBC, including basic clinical care,

prevention, psychosocial support, social and spiritual support.

TASK 3: Develop documents detailing palliative care approaches that are appropriate to the Mozambican

context

This task is pending completion of the Public Health Evaluation under Task 1, as it will use findings detailed

in the Final Survey Report as the basis for developing and/or adapting documents on palliative care

approaches. The following sub-tasks will be completed during this extension period:

Task 3a: Develop operational and policy recommendations around strengthening of referral systems, both

to health services, other sectoral services and informal services

Task 3b: Develop clear entry and exit criteria for HBC programs

Task 3c: Develop a training module around community triage for a fair distribution of the HBC client

workload within programs to improve quality services.

TASK 5: Update the Portuguese version of the "Where There is No Doctor" manual

FHI has completed the translation, revision and adaptation of all chapters of the Where There is No Doctor

Manual. The remaining steps to accomplish on this task include: finalizing illustrations, printing, distribution

and launches in selected provinces.

FHI projects that these tasks will be completed by the end of March 2009

FY08: Additional funds available through the plus-up will be used in collaboration with CDC Atlanta and the

Mozambique Ministry of Health, department of clinical laboratory services and the Mozambique Institute of

Health, to develop and implement surveillance of Cryptococcus disease amongst persons infected with

HIV. This will contribute to improved treatment and management of Cryptococcosis including Cryptococcus

meningitis amongst PLWHA.

This activity contributes to partial salary and benefits for the CDC Medical Epidemiologist and the full salary

and benefit support for the CDC Home-based Care Technical Advisor.

The Medical Epidemiologist will provide leadership in activities related to Opportunistic Infections and

TB/HIV program managment, participate in MOH, Inter-Agency, and TB/HIV Task Force meetings,

supervise TB/OI and Home-based care activities (including supervising 3 staff who work closely with MOH

on these issues), supervise cooperative agreement with Mozambique's Ministry of Women and Social

Action and lead the development and implementation of public health evaluation activities related to care

and treatment.

The Home-based Care Technical Advisor oversees and coordinates Home-based Care activities in the

MOH, Integrated Care and Support activities with MMAS and provides technical inputs to ANEMO's

(Mozambican Nurses Association) palliative care related activities and related public health evaluations and

systems development activities being carried out by various partners.

This activity sheet is also linked to activity sheets 8587, 8570 and 8637.

This FY07 funding request will support technical assistance visits from CDC for final analysis and

presentation of findings from assesmments of the feasibility of integrating 1) STI diagnoses and treatment

and 2) improved partner services into routine HIV outpatient clinical care.

Part of this request is also to continue an existing GAP 6 mechanism that, at this time, is still being finalized.

Funding will be used to develop activities related to a "Best Practices in Integrated Care and Support"

Activity Narrative: document. These best practices were identified in the National Home and Community Care Task Force

meeting that took place in August 2006 through the participation of all the major Home Based Care

implementing partners and umbrella organizations for implementing CBOs. Some of the policy issues

identified included: improved referral systems to multisectoral services, sustainable food security activities,

mechanisms for free access to OI treatment, improved monitoring and supervision systems, improved

transport systems, caring for carers to prevent burnout, and training for appropriate interaction with

community committees. This will incorporate activities related to Traditional Medicine as well.

In addition, funding from this activity will pay 100% of the salary and benefits package of the Home Based

Care Specialist and partially fund the Senior Care and Treatment Specialist.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12934

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12934 5200.08 HHS/Centers for US Centers for 6345 3526.08 GHAI_CDC_HQ $233,115

Disease Control & Disease Control

Prevention and Prevention

5200 5200.06 HHS/Centers for US Centers for 3526 3526.06 GHAI_CDC_HQ $33,292

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $223,016

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

1. ETR program manager is no longer funded here

2. Funding for the Treatment/lab/M&E officer is now included

3. Funding for the Medical Epidemiologist is now included

Funding under this activity will be used to support partial funding for staff positions that contribute part of

their time in supporting the treatment program as follows:

ART Site Coordinator: Works to oversee all aspects of care and treatment scale-up at site level, this

involves frequent travel and close linkages with staff from partner organizations in the field including

supporting activities to improve quality of treatment scale-up (e.g. HIVQUAL). The position holder is

responsible to coordinate monthly USG Treatment Partner's Meeting; oversees all USG-funded renovation

and construction activities and supervises the ART site assistant

Senior Treatment Coordinator: Is responsible for USG-supported HIV treatment scale-up, chairs the USG

Interagency Treatment Working Group, is the main liaison with SCMS (Supply Chain Mgmt. System) for

ARV drug related issues, oversees COP planning related to HIV treatment activities, provides technical

leadership to MOH, USG and partners on treatment issues and supervises the Pediatric Treatment position

(to be recruited)

Treatment/Lab/M&E officer :Works within the treatment team to support ART and lab related program

monitoring activities including: evaluating progress in program implementation, compiling, maintaining and

reporting on data records related to partner reports and proposal submissions; data compilation needed for

routine program monitoring, COP preparation and semi-annual and annual reports

Medical Epidemiologist: Will provide leadership in activities related to Opportunistic Infections and TB/HIV

program managment, participate in MOH, Inter-Agency, and TB/HIV Task Force meetings, supervise TB/OI

and Home-based care activities (including supervising 3 staff who work closely with MOH on these issues),

supervise cooperative agreement with Mozambique's Ministry of Women and Social Action and lead the

development and implementation of public health evaluation activities related to care and treatment.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15812

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15812 15812.08 HHS/Centers for US Centers for 6345 3526.08 GHAI_CDC_HQ $215,869

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $0

ACTIVITY UNCHANGED FROM FY2008

No new funding in FY09

This PHE activity, "Evaluation of HIV Viral Load and Prevalence of HIV Drug Resistance in HIV-infected

Children Receiving ART in Mozambique", was approved for inclusion in the COP. The PHE tracking ID

associated with this activity is MZ.07.0197. This PHE was proposed and approved during the plus-up cycle

in FY07, but there was no activity created for it in COP 08. Its PHE tracking number was assigned later.

Therefore, it is labeled as a "new" activity, but in reality it is continuing from FY07.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.10:

Funding for Care: TB/HIV (HVTB): $35,345

Continuing Activity:

Funding for this activity will support the partial salary and benefits of the Medical Epidemiologist who will

provide leadership in activities related to Opportunistic Infections and TB/HIV program managment,

participate in MOH, Inter-Agency, and TB/HIV Task Force meetings, supervise TB/OI and Home-based care

activities (including supervising 3 staff who work closely with MOH on these issues), supervise cooperative

agreement with Mozambique's Ministry of Women and Social Action and lead the development and

implementation of public health evaluation activities related to care and treatment.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12935

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12935 5226.08 HHS/Centers for US Centers for 6345 3526.08 GHAI_CDC_HQ $35,345

Disease Control & Disease Control

Prevention and Prevention

8629 5226.07 HHS/Centers for US Centers for 4865 3526.07 GHAI_CDC_HQ $160,305

Disease Control & Disease Control

Prevention and Prevention

5226 5226.06 HHS/Centers for US Centers for 3526 3526.06 GHAI_CDC_HQ $200,000

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.12:

Funding for Prevention: HIV Testing and Counseling (HVCT): $131,805

Continuing Activity:

Proposed funding under this activity supports the salary and benefits package of the CDC HVCT Technical

Advisor's position. The CDC CT Technical Advisor works directly with the MoH HIV/AIDS Program

Directors, CT Program staff on the development and review of National CT program policies, guidelines and

training materials, co-facilitates training of trainers, and provides on-the-job

mentoring to MOH CT program staff.

The CT Advisor also co-chairs the CT Task Force of the National Prevention Reference Group, chairs the

USG CT Partners' working

group, that meets periodically to exchange information to discuss implementation challenges encountered

across partners, to develop

plans and provide recommendations as to overcome these challenges. The CT Advisor facilitates linkages

between the MOH PMTCT team and the USG CT implementing partners.

The CT and M&E Advisors work together to provide technical assistance and inputs relevant to M&E

aspects of the PMTCT program, including improvements in regards to CT data compilation, analysis, use

and improvement of

CT M&E registers and tools.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12936

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12936 5210.08 HHS/Centers for US Centers for 6345 3526.08 GHAI_CDC_HQ $205,410

Disease Control & Disease Control

Prevention and Prevention

8620 5210.07 HHS/Centers for US Centers for 4865 3526.07 GHAI_CDC_HQ $211,738

Disease Control & Disease Control

Prevention and Prevention

5210 5210.06 HHS/Centers for US Centers for 3526 3526.06 GHAI_CDC_HQ $118,606

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.14:

Funding for Treatment: ARV Drugs (HTXD): $128,232

ACTIVITY UNCHANGED FROM FY2008

Funding in this activity supports the partial salaries and benefits for two positions: The senior treatment

Coordinator and the ART site Coordinator.

The Senior treatment coordinator: Is responsible for USG-supported HIV treatment scale-up, chairs the

USG Interagency Treatment Working Group, is the main liaison with SCMS (Supply Chain Mgmt. System)

for ARV drug related issues, oversees COP planning related to HIV treatment activities, provides technical

leadership to MOH, USG and partners on treatment issues and supervises the Pediatric Treatment position

(to be recruited)

The ART site coordinator: Works to support all aspects of care and treatment scale-up at site level, this

involves frequent travel and close linkages with staff from partner organizations in the field including

supporting activities to improve quality of treatment scale-up (e.g. HIVQUAL). The position holder is

responsible to coordinate monthly USG Treatment Partner's Meeting; oversees all USG-funded renovation

and construction activities and supervises the ART site assistant

New/Continuing Activity: Continuing Activity

Continuing Activity: 12937

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12937 8621.08 HHS/Centers for US Centers for 6345 3526.08 GHAI_CDC_HQ $116,307

Disease Control & Disease Control

Prevention and Prevention

8621 8621.07 HHS/Centers for US Centers for 4865 3526.07 GHAI_CDC_HQ $49,948

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.15:

Funding for Laboratory Infrastructure (HLAB): $183,687

ACTIVITY UNCHANGED FROM FY2008

Funding in this activity will be used to pay partial salary and benefits packages for the Treatment and Lab

Monitoring and Evaluation Officer (50%) and the full salary and benefits package of the Sr. Laboratory

Specialist. Each of these positions provides significant support to the Laboratory Infrastructure program,

one of the key PEPFAR programs.

CDC - GHAI-HQ-Salary Distribution: Senior laboratorian (100%)

CDC - GHAI-HQ-Contract Distribution: Treatment /lab M and E officer (50%)

New/Continuing Activity: Continuing Activity

Continuing Activity: 12939

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12939 5268.08 HHS/Centers for US Centers for 6345 3526.08 GHAI_CDC_HQ $240,942

Disease Control & Disease Control

Prevention and Prevention

8623 5268.07 HHS/Centers for US Centers for 4865 3526.07 GHAI_CDC_HQ $201,275

Disease Control & Disease Control

Prevention and Prevention

5268 5268.06 HHS/Centers for US Centers for 3526 3526.06 GHAI_CDC_HQ $40,000

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.16:

Funding for Strategic Information (HVSI): $843,152

Continuing Activity:

This is a continuation of activity 4993.08.

This activity provides funding for the salary, benefits packages, and program-related travel for five positions

- (1) Sr. SI Specialist (2) Surveillance/Surveys Officer, (3) Associate Director of Science, (4) Informatics

Advisor and (5) M&E Advisor.

1) Sr SI Specialist/Medical Epidemiologist (Sr. Strategic Information Coordinator) (USDH): The incumbent is

the team lead for the CDC SI team (USDH) and is an integral member of all SI-related activities in PEPFAR.

She is responsible for the principle management and oversight of the collaborative program design,

implementation, monitoring and evaluation of primary prevention activities, analyzing program data through

statistical methods, and disseminating study results through scientific journals, periodic reports and public

presentations. The Sr. SI Coordinator also supports SI activities at the Ministry of Health and other partner

organizations. These activities include HIV-related surveillance and surveys, informatics, Public Health

Evaluations and M&E.

(2) The Surveillance/Surveys Officer oversees technical assistance provided for surveillance activities and

surveys which CDC supports, including sentinel surveillance, and national seroprevalence and behavioral

surveys. The Surveillance/Surveys Officer provides technical assistance to the MOH to assist with

development of its surveillance program and its ability to conduct national surveys. Finally, the

surveillance/surveys officer will be the primary point of contact with multisectoral bodies such as the

Multisectoral Working Group, coordinating CDC participation in and support of data triangulation activities

with the NAC and UNAIDS. This position is currently filled.

(3) Associate Director of Science (ADS) The main duties of the ADS Advisor are to plan, initiate, conduct,

evaluate, and coordinate public health evaluations and other complex HIV/AIDS applied empidemiologic

research, surveillance, monitoring, evaluation, epidemiological response, and program activities in

Mozambique concerned with the reduction of HIV transmission and mitigating the impact of HIV and AIDS.

The ADS assists and provides oversight in the design and implementation of epidemiological studies,

public health evaluation, and basic program evaluation activities in Mozambique. The ADS is also

responsible for building capacity among USG partners in developing and implementing PHE and operations

research projects and protocols, ensuring ethical standards are met, and tracking IRB and other ethical

approval submissions. This position is currently filled.

(4) Informatics Advisor. Under the guidance of the CDC Country Director and the Senior Technical Advisor

for Strategic Information (SI), the Informatics Advisor will play a critical role in strengthening capacity and

systems for informatics in the Government of Mozambique's Ministry of Health to measure the national

response to HIV/AIDS in Mozambique. This position serves as a technical expert and consultant in the

areas of informatics, data analysis, software analysis, design, development, electronic communications

(including the Internet) and computer hardware support. Within the SI team, this advisor helps to establish

the direction and scope of the technical informatics activities of CDC/Mozambique and provides consultation

on the information resources and technologies needed to perform program activities. Finally, this advisor

provide technical leadership and oversight in directing, managing, planning, developing, coordinating and

evaluating public health informatics programs and activities in support of the Ministry of Health (MOH). This

position is not currently filled but this position should be advertised by the end of CY 08.

(5) M&E Advisor. Under the guidance of the CDC Country Director and the Senior Technical Advisor for

Strategic Information (SI), the Monitoring and Evaluation (M&E) Advisor plays a critical role in strengthening

capacity and systems for M&E in the Government of Mozambique's Ministry of Health to measure the

national response to HIV/AIDS in Mozambique. As well, the M&E specialist works with USG partners at

both implementer and national levels to quantify progress towards targets set for PEPFAR. The M&E

Specialist advises the CDC Senior Technical Advisor for SI on all matters related to the development and

strengthening of routine HIV/AIDS related program reporting systems in Mozambique. Specifically, the M&E

Specialist works to strengthen systems and staff capacity at the MOH to collect, manage, and use quality

M&E data to inform programs and policies in the national response to HIV and AIDS. The M&E Specialist

also has responsibility for assisting the PEPFAR team in measuring the USG contribution toward achieving

the Emergency Plan targets through MOH reporting systems, and to adapt PEPFAR-supported M&E and

other Strategic Information tools to improve Emergency Plan programming and service delivery. This

position is currently filled.This is a continuation of activity 4993.08 in COP 08.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12940

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12940 4993.08 HHS/Centers for US Centers for 6345 3526.08 GHAI_CDC_HQ $1,273,549

Disease Control & Disease Control

Prevention and Prevention

8632 4993.07 HHS/Centers for US Centers for 4865 3526.07 GHAI_CDC_HQ $1,395,805

Disease Control & Disease Control

Prevention and Prevention

4993 4993.06 HHS/Centers for US Centers for 3526 3526.06 GHAI_CDC_HQ $600,500

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.17:

Funding for Strategic Information (HVSI): $0

ACTIVITY UNCHANGED FROM FY2008: (No new funds for FY09)

The activity is continuing and is in the data analysis phase.

Title: HIV Risk in Sex Workers and Drug-Using Populations in Maputo, Beira, and Nacala Porto,

Mozambique: An International Rapid Assessment, Response and Evaluation (I-RARE)

Project Description:

The I-RARE assessment and training package will provide Mozambican health professionals and

researchers with the skills to conduct qualitative assessments for vulnerable populations, including drug

users, commercial sex workers and MSM. These groups frequently engage in illegal or socially stigmatised

behaviours and have less access to HIV/AIDS services than the general population.

Evaluation Question:

This evaluation intends to answer the following questions:

1. Can vulnerable and hidden high risk populations be reached in order to implement HIV prevention

interventions?

2. Can these populations be provided with risk reduction information and supplies to assist them in

preventing HIV, and can they be linked to counseling and testing, HIV/AIDS care and treatment services,

including diagnosis and treatment for opportunistic and sexually transmitted infections where needed?

3. Will these populations reduce their risk upon access to these interventions, including both drug-using and

sexual behaviors?

4. Will these populations utilize the services they are referred to?

The protocol had approval from the ethical reviews in the US and the Bioethics Committee in Mozambique.

Data from the rapid evaluation will be used to inform the scale-up of programs in the following years.

Planed use of findings:

Results of the assessment will be used to strengthen community outreach to vulnerable groups and

systems for referrals to HIV prevention, care and treatment services. The major emphasis will be the

development of networks, linkages, and referral systems between outreach workers, NGO/CBOs and health

care service providers.

PROGRESS REPORT

During FY08, I-RARE data collection was conducted and analysis began in line with the approved protocol

from FY07. Training was provided by CDC Atlanta to the field teams on I-RARE methodology and to the

University of Eduardo Mondlane data analysis team on qualitative data analysis. Field teams conducted

data collection from November - December 2007 in Maputo, Beira, and Nacala Porto.

Data collection included: a) key informant and focus group interviews with sex workers, drug users, clients

of sex workers, service providers, and policy makers; b) demographic surveys from sex workers, drug

users, and clients of sex workers; and c) voluntary HIV and Syphilis (Maputo-only) testing and counseling

for sex workers, drug users, and clients of sex workers. The study aimed at collecting 100 key informant

interviews from sex workers, drug users, clients of sex workers, service providers, and policy makers and

10 focus groups with drug users, sex workers, and service providers in each site. In total from all three

sites, 302 key informant and 30 focus groups were conducted.

Key informant interviews, demographic surveys, and HIV and Syphilis testing results were sent to CDC

Mozambique from Maputo, Beira, and Nacala Porto field teams in January and February of 2008. The data

was complied and reviewed at CDC Mozambique then sent to the University of Eduardo Mondlane for

analysis.

To date, the University of Eduardo Mondlane team has completed analysis of the demographic surveys and

are transcribing and analyzing the key informant and focus group interviews. Data analysis should be

completed by the end of 2008 with a report and dissemination meeting in 2009.

Personnel Changes:

Rich Needle, PI from CDC-Atlanta was replaced by Karen Kroeger from CDC Atlanta as PI.

Obstacles:

A delay occurred in beginning data analysis because of contractual issues between CDC and the University

of Eduardo Mondlane, which have been resolved allowing data analysis to begin.

Budget justification for FY09:

Completion of project will be done using budgeted funds for FY08; no additional funding is being requested

for FY09.high-risk group members.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15890

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15890 15890.08 HHS/Centers for US Centers for 6345 3526.08 GHAI_CDC_HQ $0

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.17:

Funding for Strategic Information (HVSI): $900,000

April09 Reprogramming: Reduced $100,000.

THIS IS A NEW ACTIVITY

This is a new activity in that it is organized as its own separate activity, but is a continuation of the

subactivity listed as Activity 4993.08 in COP 08.

Mozambique has not yet implemented a round of Behavioral Surveillance. A pre-formative project was

conducted in FY08 to help the Government of Mozambique and other stakeholders to identify and prioritize

key risk groups (Phase 1). Current groups proposed for inclusion in BSS include female commercial sex

workers, young women involved in transactional sex, miners and their partners, and long distance truck

drivers. This will be followed by the formative phase to develop plans and protocol for BSS+

implementation (Phase 2). Ultimately 3-4 groups will be included in the BSS; final selection of these groups

will be dependent on Phase 2 activities including an assessment of feasibility of inclusion of each group.

Phase 2 will be followed by Phase 3, the survey implementation phase. Currently it is planned that the

survey will include a biomarker to estimate HIV prevalence for these groups. Funds will be used for

technical assistance needed to plan and implement Phase III, required commodities and lab supplies for

BSS implementation, contracting of local field teams for data collection and entry, and technical assistance

for data analysis and dissemination.

Some funds were allocated for BSS with 07 Plus-up monies ($422,000) and COP 08 monies ($578,000).

However, based on the experiences of other countries implementing BSS (including Angola), and that fact

that some characteristics of Mozambique including limited physical infrastructure compounded with the

need to coordinate a complex survey in Portuguese, we anticipate that a minimum of $2.225 million will be

needed to implement a survey that includes four groups.

$1,000,000 is requested in CDC HQ-based funds to support costs related to field implementation of the

study (BSS). This will complement the $25,000 being requested in COP 09 through the SI Program area

(local) and the $200,000 being requested in COP 09 through the Other Prevention program area.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.17:

Funding for Strategic Information (HVSI): $100,000

THIS IS A NEW ACTIVITY

Until vacancies on the Strategic Information team are filled, the Strategic Information Team remains reliant

on short term technical assistance including that of EIS officers, Presidential Management Fellows (PMF),

and other TDYs. The SI team also uses short-term assistance such as those listed above to complete

projects and activities that require skill sets that are not already part of the SI staff or to carry out small

projects that require focused time and attention. In past years, monies for this type of assistance have not

been budgeted for. The SI team is budgeting these funds so that needed assistance can be accessed for

activities including but not limited to:

*adaptation of the PEPFAR COP and APR database to reflect PEFPAR 2 needs

*assistance with standardizing geographic information and generating priority maps for PEPFAR and/or

Government of Mozambique planning

*in-depth data analysis of COP, APR/SAPR, or other programmatic data

*TDY support to develop and implement basic program evaluation activities

Although PEPFAR Mozambique continues its aggressive efforts to fill vacancies within the USG SI team,

until these positions are filled, USG in the short-term remains dependent on TDY assistance for many areas

within SI.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.17:

Funding for Health Systems Strengthening (OHSS): $450,000

This is a new activity. Here in COP 09, this is listed as its own (new) activity, but initial start-up funding for

this activity was funded through activity 19910.08 in COP 08.

As noted in other sections in this COP, a key focus for COP 09 is increasing SI capacity, specifically

building a cadre of Mozambicans with appropriate and adequate skills to carry out necessary strategic

information activities in Mozambique. The USG team is using a variety of shorter- and longer-term

strategies and activities to support this capacity. While some other SI capacity building activities (e.g. M&E

Fellowship) will be expected to increase the number of and skills of Mozambicans in Strategic Information in

the short term, several activities are being supported to increase epidemiology and other SI related skills

among Mozambicans in the long term (2 -3 year timeframe)

One of these longer term activities is CDC's Field Epidemiology Training Program (FETP) that has the goals

of providing epidemiological services to the public health system, developing self-sustaining institutionalized

capacity to train public health leaders in field epidemiology, and to strengthen the public health, information

system and laboratory (if needed). Typically trainees in the FETP participate for 2 years where 25% of their

time is in the classroom and 75% is in the field. Trainees are usually already working in MOH positions

providing epidemiological services. Trainees are closely supervised and recieve either a certificate or

degree upon completion of the program. This program has been instituted in many countries around the

world and is developing a network of Africa based FETPs, some of which have the laboratory component.

While the program has core components, it is also tailored to the needs of the country.

The Minister of Health has requested the establishment of a FETP in Mozambique. Using FY 08 funds, a

pre-assesment team will be coming in late November consisting of representatives from CDC Atlanta, CDC

Brazil and the Ministry of Health Brazil to meet with stakeholders here to initially ascertain the needs and

resources in Mozambique for the FETP. Discussions will include whether the FETP will include a laboratory

component. FY09 funds will be used to conduct a more in-depth assessment and begin the establishment

of the program, including hiring a resident advisor. Through close collaboration with CDC Brazil and the

Brazilian FETP, Mozambique can take advantage of Lusophone technical assistance providers and

curriculum materials for the FETP. FY 09 funds will be used to conduct a more in-depth assessment, hire a

resident advisor, and to advance the work of developing plans for establishing an FETP in Mozambique in

collaboration with MOH. This activity will fund necessary travel and meetings for preliminary contacts and

discussions with counterparts at other FETP sites by MOH and/or CDC staff.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $100,000

Water

Table 3.3.18:

Funding for Health Systems Strengthening (OHSS): $308,214

ACTIVITY UNCHANGED FROM FY08.

Salary

The Training Advisor provides technical assistance directly to the Ministry of Health's Training Department

on all MOH specific projects such as the development of the Training Information System, development of

the yearly plan and budget, assisting implementing partners in their work with the MOH, co-facilitating

trainings, and advising CDC technical staff on training and human resource priorities for the MOH. The

Senior Training Specialist supervises the two CDC-based training advisors and works directly with PEPFAR

funded partners and technical staff at CDC and USAID around training and Human Capacity Development

planning and implementation. Senior Training Specialist acts as the lead training/HCD staff person and in

that capacity leads the development of the COP and all other strategic planning.FYO9 funds ($308,000) will

be used to continually support salary and benefits for the Senior Training Specialist and Training Advisor.

Operational Manual

MoH decided to adapt the operational manual developed by WHO-Geneva, CDC Atlanta and USAID

Washington to the Mozambican National Health Service settings. This operational manual has recently

been finalized. It is a complementary manual to the IMAI generic set of training material on the prevention,

care and HIV treatment for health care workers. In 2008, CDC, USAID and WHO Mozambique began a

synergistic effort to help implementing the operational manual in the country. WHO Mozambique hired a

national project officer, who is responsible to coordinate the adaptation process in collaboration with the

MOH staff. In 2009, PEPFAR funds ($25,000) will contribute to hire a short term consultant to further assist

the MOH staff in the adaptation process. Funds will also be available for in-country travel.

Products/Deliverables:

Support the adaptation process of Operational Manual

New/Continuing Activity: Continuing Activity

Continuing Activity: 15682

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15682 15682.08 HHS/Centers for US Centers for 6345 3526.08 GHAI_CDC_HQ $280,812

Disease Control & Disease Control

Prevention and Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $75,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18:

Funding for Management and Operations (HVMS): $950,605

The CDC office currently has sixty-two (62) approved positions under various mechanisms - including eight

(8) direct hires, forty (40) locally employed staff, including two (2) Eligible Family Member (EFM), and

fourteen (14) contracted staff (COMFORCE, PSC). Thirty-nine (39) positions are currently filled, and twenty

-three (23) positions are currently vacant, but will be filled in the near future. Recruiting and hiring in

Mozambique has proven to be difficult on many fronts due to a lack of available hiring mechanisms

(Comforce is no longer available for overseas hires), DIRE/visa issues with the local government and

severe shortage of local human resources. Even with these tremendous challenges, CDC has been able to

fill many of the vacant positions and is on line to fill the outstanding vacancies during this next fiscal year.

Of the twenty-three (23) CDC vacant positions, selections have been made already for five (5) positions and

are only awaiting final clearances. Of these five (5) positions, two (2) are interagency in nature.

Additionally, three (3) of the 23 positions are in the final stage of the selection process, with placement

expected shortly. The remaining fifteen (15) positions are at various stages of the recruitment process, from

finalizing position descriptions to advertising positions to interviewing candidates.

Most of the costs included in the M&S budget cover expenses related to supporting the CDC staff and office

expenses. Some technical staff salaries are included in the M&S budget per COP Guidance.

This activity contains funding for various administrative activities:

- Contractual staff salaries and benefits (PSC, COMFORCE) - Sr. Prevention Coordinator

(existing),PEPFAR Coordinator - Medical Officer, Technical PHA, Senior Prevention Coordinator ($570,605)

- Shipment of things by Atlanta held Funds ($235,000)

-ITSO ($145,000)

New/Continuing Activity: Continuing Activity

Continuing Activity: 12941

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12941 8624.08 HHS/Centers for US Centers for 6345 3526.08 GHAI_CDC_HQ $554,743

Disease Control & Disease Control

Prevention and Prevention

8624 8624.07 HHS/Centers for US Centers for 4865 3526.07 GHAI_CDC_HQ $947,504

Disease Control & Disease Control

Prevention and Prevention

Table 3.3.19:

Cross Cutting Budget Categories and Known Amounts Total: $175,000
Education $100,000
Human Resources for Health $75,000