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.
Years of mechanism: 2008 2009
This PHE activity, "Moving from single dose Nevirapine to more complex antiretroviral prophylactic
regimens in PMTCT programs: assessing implementation successes and barriers", was approved for
inclusion in the COP. The PHE tracking ID associated with this activity is MZ.07.0087.
Continuing Activity: Replacement Narrative
The Columbia University International Center for AIDS Care and Treatment Programs (ICAP) will complete
implementation of the PHE, "Moving from single dose Nevirapine to more complex antiretroviral prophylactic
regimens in PMTCT programs: assessing implementation successes and barriers." This activity was
previously titled "Assessment of access, uptake and adherence to single-dose nevirapine (sdNVP)
prophylaxis among HIV-infected pregnant women." Since this project was conceptualized for FY06
planning, rapid changes have occurred in international standards for PMTCT practice, and MOH guidelines
have been revised. The protocol has been updated accordingly, and the scope has been expanded to move
beyond sdNVP to include complex ARV prophylaxis regimens.
This activity was conceptualized in FY06; new MOH PMTCT program direction and staff reorganization in
the PMTCT program has significantly delayed progress during the first year. At this time, these institutional
issues have stabilized. ICAP has significantly expanded their Mozambique-based research team.
At the moment the protocol is under final revision with headquarter & Mozambique in-country teams. The
protocol is planned to be submitted to appropriate local and US-based IRBs in October 2007. The
implementation is expected to be concluded in January 2009. Principal investigators are Dra. Lilia Jamisse,
MOH Adjunct National Health Director, and Dra. Elsa Jacinto, MOH Reproductive Health Program Director
and PMTCT Program Coordinator.
The main objectives of the study are: 1) To identify patient-level determinants of maternal and pediatric
PMTCT outcomes; 2) To identify contextual, programmatic and site-level determinants of maternal and
pediatric PMTCT outcomes; 3) To identify facility and program level characteristics that are associated with
HIV care and treatment outcomes, after adjusting for patient-level characteristics.
This study will include retrospective and prospective cohort follow-up with data from medical records and
interviews with women as well as a descriptive study of site and program characteristics. This work is vital
to identifying important programmatic aspects of HIV care and PMTCT programs for use in planning future
programs and improving existing ones in Mozambique and elsewhere.
Work will start in the field in January 2008. Findings will be shared with participants, study sites and ICAP
supported sites involved. It is also in the public interest that findings be made available to a broader range
of HIV/AIDS health care providers.
Stakeholders (MOH, USG, ICAP) will participate in the planning and presenting of the data at meetings and
conferences, as well as disseminating information through routine channels within the USG PMTCT
partners community and MOH organizational structure. Results will be submitted for publication in an
appropriate peer reviewed journal.
The estimated costs are USD 220,000; USD 70,000 will be continue to be rolled over from the FY06 budget,
and in FY08 an additional USD 150,000 is requested to fund completion of the project.
Budget justification: 1) Personnel: USD 90,000; 2) Equipment: USD 18,000; 3) Supplies: USD 10,000 4)
Travel: USD 40,000; 5) Dissemination of findings: USD 12,000; 6) Training (material development and
courses), USD 15,000; 7) Other: USD 35,000.
Participant incentives will not be issued as per current MOH guidance.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16288
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16288 16288.08 HHS/Centers for Columbia 7403 3568.08 Track 1 ARV $150,000
Disease Control & University Moz
Prevention Supplement
Emphasis Areas
Human Capacity Development
Public Health Evaluation
Estimated amount of funding that is planned for Public Health Evaluation $0
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
This PHE activity, "Evaluation of eligibility for ART in Mozambique by clinical staging performed for HIV-
infected pregnant women by ANC/PMTCT personnel and comparison to CD4 and total lymphocyte count",
was approved for inclusion in the COP. The PHE tracking ID associated with this activity is MZ.07.0086.
Continuing activity: Replacement narrative
Evaluation of eligibility for Anti-Retroviral Therapy (ART) in Mozambique by clinical staging performed for
HIV-infected pregnant women by antenatal care / prevention of mother-to-child (ANC/PMTCT) personnel
and comparison to CD4 and total lymphocyte count (TLC)
This project aims to evaluate techniques used for determining ART eligibility among pregnant women by
comparing various algorithms of clinical staging, CD4 count, total lymphocyte count, and
hemoglobin/hematocrit. Sensitivity and specificity of these tools will be compared when used by maternal
child health (MCH) nurses in the context of ANC PMTCT services in Mozambique. The study will help
determine the best method for evaluating eligibility for ART among pregnant women, in particular for sites
with limited or no access to laboratory services.
The Mozambican Ministry of Health (MOH) National PMTCT protocols currently recommend initiation of
ART for pregnant women if they are stage III or IV, or have a CD4 of less than 250/mm3 . While a network
of laboratories is being established with PEPFAR support that will in the future increase access to CD4
testing, many remote PMTCT sites will not have easy access to laboratory services for the next years. This
fact, coupled with the scarcity of skilled and trained personnel available to clinically assess patients leads to
a large contingent of HIV-infected pregnant women who are not adequately assessed for ART eligibility.
As part of conducting this PHE, training in clinical staging will be provided for participating nurses.
This activity was conceptualized in FY06 but protocol has not yet been finalized. New MOH PMTCT
program direction and staff reorganization in the PMTCT program has significantly delayed progress during
the first year. At this time, these institutional issues have stabilized. ICAP, the proposed USG implementing
partner, has significantly expanded their Mozambique-based research team. Money will be reprogrammed
from FY06 to Columbia University International Center for AIDS Care and Treatment Programs (ICAP) to
collaborate and facilitate study administration and logistics. Additional FY08 funding will also be allocated to
support completion of this activity. CDC Mozambique is actively recruiting a study coordinator who is
expected to be in place by late September or early October, 2007, to function as the lead for this activity.
To date, discussions to refine study design and implementing issues have taken place. A draft protocol has
been developed and will be presented and shared with implementing partners and other MOH staff
involved. The protocol and instruments will be vetted through the appropriate ethical reviews in the US as
well as the Mozambican Bioethics Committee in country. Principal investigators are Dra. Lilia Jamisse,
After the protocol has been cleared by the appropriate ethics boards, the assessment will take place in two
ICAP-supported PMTCT sites, with laboratory support available either on site or within proximity at the
provincial hospital laboratory. Three potential sites are currently under evaluation, and initial site
assessments have taken place. Staff will be trained in assessing patients in clinical staging according to
WHO guidelines; initial development of materials has started and is expected to be completed by
September-October 2007.
Study activities and data analysis are expected to be complete by the end of FY08.
Budget Justification: $150,000 will be rolled over from FY06/FY07 and reprogrammed to Columbia. To
enable completion of the project, $37,500 in additional funds will be allocated for FY08.
Cost centers will be 1) Personnel support, $68,000; 2) Equipment, $26,000; 3) Supplies, $12,000; 4) Travel
and specimen transport, $38,000; 5) Training (material development and courses), $23,500; 6)
Dissemination meetings, $12,000; 7) Other, $8,000.
Continuing Activity: 16286
16286 16286.08 HHS/Centers for Columbia 7403 3568.08 Track 1 ARV $37,500
Summary and background ($4,950,000)
In FY09 Columbia University (CU) / ICAP will continue PMTCT support at 41 existing sites (including 2
model centers) and expand to absorb 24 USG-supported facilities with PMTCT services in Maputo City,
Zambezia and Gaza. Transition between USG partners will start following planning meetings including
CDC and district-level MOH (DPS). In addition ICAP support for comprehensive PMTCT services will
expand to 13 sites in Maputo City, Inhambane and Nampula.
CU will emphasize Health System Strengthening (HSS) at provincial (DPS) and DDS levels, developing
capacity in PMTCT Clinical Mentoring and management of district teams. CU will work with DPS and DDS
to support supervision and, in turn, scale up comprehensive PMTCT care at all sites. CU will roll out
counseling and testing at sites and strengthen linkages between PMTCT & ART services. CU will enhance
infant & child initiatives to increase enrollment and retention in care, ART initiation, access to adequate
infant feeding, and counseling and support services. Activities will include building maternal and child health
(MCH) staff capacity, strengthening coordination with the early infant diagnosis (EID) program, developing
infant feeding tools, piloting the provision of micronutrients, implementing infant feeding support groups and
revitalizing the Baby Friendly Hospital Initiative.
(1) Support for comprehensive PMTCT Activities - continuation and expansion ($3,235,000)
Integration of PMTCT into HIV care & treatment services is critical to provide more effective PMTCT
interventions for HIV-infected pregnant women. CU will continue to emphasize this comprehensive
approach, building on MCH services, focusing on access to ART and more complex PMTCT regimens, as
well as cotrimoxazole (CTX) prophylaxis for women in ANC. CU will also enhance MCH services, including
training for providers in CTX prophylaxis based on WHO guidelines, provision of malaria prophylaxis to
pregnant women including ITNs in coordination with PMI, strengthening TB screening, continued support for
dual protection and integrating HIV counseling and testing (CT) into family planning (FP) services.
Integration and uptake of FP services has been weak in Mozambique, and has not been a focus of USG
Mozambique. ICAP will increase efforts to improve access to FP services for HIV-infected women,
particularly post-partum (including coordination of postpartum visits and FP services).
In order to increase ART initiation amongst pregnant women, CU will continue to build a PMTCT network
focused on integrated services in ART clinics, as well as strengthening referral systems between PMTCT
and ART services. At model centers, HIV treatment will be integrated into PMTCT services, coordinated
through an MCH-focused ART committee to facilitate rapid initiation of ART for pregnant women.
In FY09, the proportion of women initiating ART will increase to 20% (2673) from 8% in FY08, among all
women receiving ARV's for PMTCT. Consequently the proportion of women receiving single-drug regimens
with sdNVP and AZT will decrease from 28% to 20%, and 62% to 60%, respectively. Activities to optimize
adherence and retention in care include enhancing patient support by training MCH staff in skills and quality
of care with a focus on adherence monitoring and counseling, group management skills, and psychosocial
support. CU will expand mother support groups to 24 sites (8 in Maputo, 5 in Zambezia/Gaza, 4 in
Inhambane). In Nampula, mothers2mothers will implement their model in 17 support groups. IEC
materials for patients & health care staff to guide group sessions will be developed.
Promotion of male-friendly models of care in MCH will be expanded by distributing written invitations to all
pregnant women at ANC & increasing MCH staff motivation to involve men by conducting sensitization
sessions during regular monitoring meetings.
Peer educators will be trained in outreach services/defaulter tracing to improve adherence and increase
treatment literacy. Activities will include capacity building of expert patients in PMTCT and HIV care and
treatment, designing materials appropriate for low-literacy audiences and PMTCT training of trainers for
peer educators.
Traditional birth attendants (TBAs) will continue to promote mother-infant follow up and ensure linkages
between the community & MCH sector. Four trainings will be held in Nampula and Inhambane to build TBA
capacity. Supervision and stipend/incentives for home-based care will be provided.
Support for infant/child health care initiatives will also be incorporated as part of the PMTCT continuum.
Regular follow up of women & children is required to promote safe infant feeding practices and improve
infant outcomes. To optimize adherence and retention in care, CU will provide nutrition education and
counseling targeted at pregnant women and infants, micronutrient sprinkles for porridge fortification, and
linkage to supplementation and food security programs. In addition new infant feeding support groups will
be developed at 16 sites and continued at 14. Promotion of early initiation of breastfeeding and good
practices in HIV context will continue at all sites by training 80 health staff at ANC and Maternities. The
Baby Friendly Hospital Initiative will be revitalized at 48 maternities and daily breastfeeding group sessions
for all women delivering in maternity will be promoted.
Infant and child health care initiatives will be prioritized by rapid identification of HIV exposed infants,
implementation of a referral system, and early consistent follow up of HIV exposed infants in at-risk child
consultations (CCR). EID training and mentoring of health staff on linkages between EID and MCH services
will be coordinated to improve patient follow-up. "Family days" will be supported at facilities with both
PMTCT and ART services.
(2) Supporting and strengthening MOH district health teams to scale up PMTCT and expand PMTCT
coverage ($420,000)
Using a district team approach, CU will expand support to PMTCT in 8 districts in Nampula, Inhambane,
Zambezia and Gaza. Funds will be used for on-site mentor training to enhance supervisory skills, as well
as site assessments to improve patient services and flow. Support will also be provided to ensure
consistent stock of ARV drugs and other necessary materials by strengthening the link between PMTCT
and pharmacy services. CU will work with SCMS to develop feedback systems for supply management at
DDS/DPS level. In the shift from direct site support to district level health systems strengthening, CU will be
lead partner in Nampula, Inhambane and Maputo City and proposes PMTCT TA positions for Nampula and
Inhambane to strengthen DPS capacity.
CU will continue to build capacity by supporting district and facility level trainings in all districts to improve
quality of M&E for PMTCT. At a national level, in collaboration with the MOH PMTCT Technical team, CU
will support review of program registers & assist in strengthening data links between PMTCT, care &
treatment, and infant follow up services. National M&E support will emphasize quality assurance. CU will
provide a fully seconded technical advisor to the MOH, as well as develop an electronic patient tracking
system & implement a national database.
Activity Narrative: CU will continue FY08 activities, including development and piloting of the PMTCT patient database to track
HIV+ mothers across health systems (ANC, maternity, care & treatment and CCR).
(3) Human capacity development ($1,095,000)
PMTCT Clinical Mentoring was launched in FY08 at model centers, which will continue to serve as
reference centers providing support at a provincial level. Trained mentors will conduct routine supervisory
visits at sites in order to ensure delivery of quality services consistent with national PMTCT guidelines.
Additionally, CU will start Clinical Mentoring in 8 more districts. A total of 50 staff from district teams will be
trained as mentors/supervisors to oversee PMTCT program implementation at district level, and 92 nurses
from peripheral sites will participate in the mentoring rotation. During FY09, CU will continue collaboration
with I-TECH to evaluate and revise PMTCT clinical mentoring tools.
CU will support DPS level trainings to increase number of MCH staff trained in PMTCT, including CT, infant
follow-up. and safer infant feeding practices.
(4) Central-level MOH Personnel Support ($200,000)
CU will support the MOH by providing direct TA to PMTCT M&E activities as mentioned above. Efforts will
also focus on improving district-level utilization of data, including feedback to site level. Due to the lack of
PMTCT support within the MOH, CU will continue to provide a data entry clerk to help with PMTCT program
monitoring as well as an admin assistant to facilitate internal MISAU coordination and communication
between MISAU and partners and program implementers.
Continuing Activity: 16284
16284 5208.08 HHS/Centers for Columbia 7403 3568.08 Track 1 ARV $3,165,000
8567 5208.07 HHS/Centers for Columbia 4859 3567.07 UTAP $2,603,125
Disease Control & University
Prevention
5208 5208.06 HHS/Centers for Columbia 3567 3567.06 UTAP $1,091,000
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Malaria (PMI)
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $300,000
and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Commodities $75,000
THIS ACTIVITY SHEET WAS MODIFIED IN THE FOLLOWING WAYS:
Columbia University's (CU) scale-up of treatment services is supported by USG and guided by
Mozambique's national HIV strategic plan. In collaboration with the Ministry of Health (MoH), CU will
continue support 42 HIV care and treatment facilities at various stages of development and expansion in
Maputo City, Gaza Province, Inhambane Province, Nampula Province, and Zambezia Province. CU also
plans to initiate support at 12 additional facilities. Expansion plans are in accordance with MoH policy.
Special emphasis will be maintained on the decentralization/integration process with special regard to urban
settings. Major urban treatment facilities will be enabled to down refer stable patients on treatment and
urban Health Centers will be able to start new patients on TARV. Complicated cases and treatment failures
will be managed at bigger facilities. This is a part of a national process of decentralization that, according to
initial MoH chronogram should be completed by December 2009.
Support to clinical services includes technical support to diagnosis, prophylaxis and treatment of
opportunistic infections including pain management. On the job training activities and formal training at site
and provincial level includes the OI component. At facilities where CU is supporting major renovations, the
physical space allows areas for cytostatics preparation and administration for SK. CU supports the training
of staff on cystostatic preparation and on Kaposi Saroma treatment.
CU will continue to facilitate the nutritional assessment and distribution of nutritional supplements to patients
through mechanisms to be determined in partnership with USAID on the basis of MoH approved clinical
criteria at Maputo Military Hospital. (420 beneficiaries)
CU will maintain and expand the monitoring and evaluation system that captures valuable information on
opportunistic infections and will continue to work with clinical staff to improve the quality of filling in forms.
This will be done through periodic site visits to sites from the provincial data officers and with the support
from M&E technical staff from the central office.
Educational activities carried out through peer educators and support groups will include messages
regarding CTX prophylaxis, nutrition and hygiene education.
CU will work to establish partnerships with community organizations working on Home Base Care to link
health facility services with home care.
Total: $177,585
FY08: Columbia University works in 7 provinces in Mozambique (Maputo, Gaza, Inhambane, Nampula,
Zambezia, Maputo City, and Tete province where Columbia works with the military to provide services. In all
these sites, support is provided for the implemention of HIV care and treatment programs that include staff
training and mentoring, infrastructure improvements, procurement of materials and supplies needed at
facility level, hiring of staff to support service provision and program monitoring and evaluation, as well as
technical and clinical advisors. These activities are also described in other parts of this document.
During FY08 Columbia University-ICAP will continue to support and expand HIV related care activities at
these sites with a view of decentralising services to remote facilities while improving patient follow up,
referral and initiation of ART services. The following activities will be implemented:
1. Strengthen the management OI drugs at supported Care and treatment facilities through: training of
pharmacy staff in OI management including how to monitor adherence; implementation of drug
management systems (computer and paer based), support provincial warehouse to strenghthen referral
systems, logistics systems and staff training in drug managment; Procurement of OI medication for
treatment of adults, infants and children in case of stock outs at CU supported sites: additionally CU will
continue to work with the MOH and SCMS in ensuring that sites implement recommended drug mangment
procedures to strenghthen the current logistics system.and Implement logistic systems to help ensure
continuous supply of medications (in coordination with CMAM/SCMS);
2. Support the diagnosis and treatment of Opportunistic Infections: Implement syndromic approach for
treatment of STIs and screening for HPV/cervical cancer through training and procurement of equipment
and supplies;. Implement case-finding, prevention and treatment of Malaria through training and in
collaboration with PMI and the PSI programs, procurement of bed nets and other supplies; Support
improvement and expansion in the detection and treatment of Kaposi's Sarcoma through training health
staff in chemotherapeutic agents preparation/KS treatment, renovation and outfitting of treatment areas, and
implementation of an M&E system to track incidence and prevalence of KS; Implement patient follow up for
patients not yet initiating ART ensuring that they receive cotrimoxazole, have access to nutrition programs
(World Food Program) are followed up regularly and initiated on ART once they are eligible for treatment
3. Improve links with community HIV care programs through development of Memoranda of understanding,
sub-agreements, with Comunity based organistaions and PLWHA support groups.
Support diagnosis, treatment and prevention of opportunistic infections: Implement syndromic approach for
treatment of STIs and screening for HPV/cervical cancer; Provide training, lab testing, and procurement of
equipment and supplies for diagnosis and t
Strengthening OI management by providing training to pharmacists, implementation of software ,
monitoring of adherence , continued education for health staff, supervision and M & E and procurement of
essential Oi drugs
Continuing Activity: 16283
16283 5198.08 HHS/Centers for Columbia 7403 3568.08 Track 1 ARV $640,000
8566 5198.07 HHS/Centers for Columbia 4859 3567.07 UTAP $680,000
5198 5198.06 HHS/Centers for Columbia 3567 3567.06 UTAP $380,000
Estimated amount of funding that is planned for Human Capacity Development $75,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $20,000
Table 3.3.08:
This PHE activity, "Identifying optimal models of HIV care and treatment in Mozambique", was approved for
inclusion in the COP. The PHE tracking ID associated with this activity is MZ.07.0079
Continuing activity from FY06 - activity number 5250.06
Columbia University will continue to conduct the PHE called "Identifying Optimal Models of HIV Care and
Treatment in Mozambique" (this study was entitled "Assessment of influence of quality of services on
clinical outcomes" in COP 2006) approved by local and Columbia University IRB in June 2007, and
expected to be concluded in June 09. The study will be submitted to CDC Atlanta IRB in Sept 2007. The
estimated costs are 50,000 USD. 54% of the total amount will be expended by February 2008. The local
coinvestigators
are: Dr Americo Assane, Chief of Department of Medical Assistance, Mozambican Ministry of
Health; Dr. Florindo Mudender, Department of Medical Assistance, Mozambican Ministry of Health. The
main objectives of the study are: 1) To assess the degree of variation in patient outcomes across HIV care
and treatment delivery sites, independent of the differences in patient-level characteristics across sites; 2)
To identify facility and program level characteristics that are associated with HIV care and treatment
outcomes, after adjusting for patient-level characteristics; 3) To assess the costs and clinical benefits of
modifying facility and program-level characteristics that appear to influence HIV care and treatment
outcomes and quality adjusted life years (QALYs). Secondary analysis of routinely collected patient data
combined with data from routine assessments of facility and program level characteristics will be used. This
work is vital to identifying important programmatic aspects of HIV care and treatment programs for use in
planning future programs and improving existing ones in Mozambique and elsewhere. Current status: the
first round of data collection is expected to start in October 2007. Findings will be shared with participants,
study sites and ICAP supported sites involved. It is also in the public interest that findings be made available
to a broader range of HI/AIDS health care providers. For FY08 is expected to continue the following rounds
of data collection. Budget justification: 1) Salaries: USD 22,400; 2) Equipment: USD 11,600; 3) Travel: USD
16,000. Total: USD 50,000>
Note: This evaluation in one of three PHEs that come from activity 5250.06. The total amount of funds for
these evaluations remain at USD 500,000, although individual studies have changed their initial budget
totals (in agreement with CDC GAP Mozambique).
Continuing Activity: 16278
16278 16278.08 HHS/Centers for Columbia 7403 3568.08 Track 1 ARV $0
Table 3.3.09:
This PHE activity, "Assessing the acceptability, effectiveness and cost benefit of two interventions to
improve long-term adherence to ART among adults receiving HIV care and treatment in Mozambique", was
approved for inclusion in the COP. The PHE tracking ID associated with this activity is MZ.07.0080.
Continuing activity from FY06 - Activity number 5250.06; FY08 Act. ID 16279
Columbia University will continue to conduct the PHE called "Assessing the acceptability, effectiveness and
cost benefit of two interventions to improve long-term adherence to ART among adults receiveing HIV care
and treatment in Mozambique" (it was designated as "Assessment of the effectiveness of peer-based
adherence support in maintaining and improved adherence to ART" in COP 06). The analysis regarding
cost effectiveness will conducted by CDC Atlanta. The protocol is in development and should be submitted
to Local, Columbia University and CDC Atlanta IRBs in October 2007. The estimated costs are USD
150,00. 54% of the total amount will be expended by February 2008. The local co-investigators are: Dr
Americo Assane Chief of Department of Medical Assistance, Mozambican Ministry of Health; Dr. Florindo
Mudender, Department of Medical Assistance, Mozambican Ministry of Health. The main objectives of the
study are to: 1) assess the effectiveness of two adherence support interventions, 2) identify factors
associated with sub-optimal adherence to ART at 3, 6, and 12 months after ART initiation, 3) estimate the
costs and clinics benefits and determine the acceptability of these two adherence support interventions.
Design: A two-pronged separate sample pre-post design will be used to assess the impact of a two
adherence support intervention. Both adherence interviews with patients enrolled in pre and
postinterventions
cohorts and data abstraction of routinely collected immunological and virological data for all
patients (i.e. those enrolled and not enrolled in the cohorts) before and after the intervention's
implementation will be conducted.This work is vital to identifying relevant programmatic enablers and
barriers for long term ART adherence in adults. Current status: the protocol is in final phase of development
and should be submitted to local, Columbia University and CDC Atlanta IRBs in October 2007. Findings will
be shared with participants, study sites and ICAP supported sites involved. It is also in the public interest
that findings be made available to a broader range of HIV/AIDS health care providers. Budget justification:
1) Salaries: USD 137,000; 2) Equipment: USD 4,000; 3) Travel: USD 6,000; 3) Office supplies: USD 3,000,
Total: USD 150,000
Continuing Activity: 16279
16279 16279.08 HHS/Centers for Columbia 7403 3568.08 Track 1 ARV $0
This PHE activity, "Establishment of sentinel cohorts of patients in HIV care and treatment services in
Mozambique", was approved for inclusion in the COP. The PHE tracking ID associated with this activity is
MZ.07.0081.
Continuing activity - FY06 Activity number 5250.06
Columbia University will continue to conduct the PHE called "Establishment of sentinel cohorts of patients in
HIV care and treatment services in Mozambique" (it was nominated as "Assessment of Viral load as a
predictor of therapeutic failure as compared to CD4 Count) and future clinical outcomes " in COP 06). At the
moment the protocol is under NY & in-country team revision. It should be submitted to Mozambican,
Columbia University and CDC Atlanta IRB in October 2007. The study is expected to be completed by
December 09. The estimated costs are 300,000 USD. 65% of the total amount will be expended by
February 2008. The local co-investigators are: Dr Americo Assane, Chief of Department of Medical
Assistance, Mozambican Ministry of Health; Ilesh Jani, Department of Immunology, National Institute of
Health. The main objective of the study is to characterize the clinical, immunologic and virologic
characteristics and keys short-term (early) program outcomes among adult (= 15y) and pediatric (<15y)
patients with confirmed HIV infection who are enrolled in HIV care and treatment programs in Mozambique.
It will be a multi-site, prospective cohort study. This work is vital to identifying important programmatic
aspects of HIV care and treatment programs for use in planning future programs and improving existing
ones in Mozambique and elsewhere. Current status: to be sent to local, Columbia University and CDC
Atlanta IRBs in October 2007. Findings will be shared with participants, study sites and ICAP supported
sites involved. It' is also in the public interest that findings be made available to a broader range of HI/AIDS
health care providers. For FY08 is expected to continue the next rounds of data collection. Budget
justification: 1) Personnel: USD 71,000; 2) Equipment: USD 4,000; 3) Travel: USD 10,000; 4) Supplies:
USD 215,000. Total: 300,000
Continuing Activity: 16281
16281 16281.08 HHS/Centers for Columbia 7403 3568.08 Track 1 ARV $0
April09 Reprogramming: Increased $1,273,019.
This is a continuing activity: Update to an existing narrative
This activity is a continuation of treatment activities that were initiated in FY04-7 as part of Columbia
University Track 1.0 supplemental funding. Funding will be used to continue supporting 30 ART sites
(including 3 military facilities and initiate support to 4 new ART facilities), as well as training of health
workers, technical assistance to the district and provincial and central level MOH and ensure quality of
services provided through continuous program monitoring and evaluation, site supervision and linkage with
Community Based Organizations. Funding during FY08 will be used for the recruitment of doctors,
counselors and nurses, and to support the provision of a broad range of technical services directly to
Provincial and District Health Authorities.
Support will be provided to pediatric treatment scale up at all CU supported ART sites as well as specifically
to the pediatric Day Hospitals in Maputo and Nampula Central hospitals. CU will support the logistics
required to undertake PCR using DBS at site level, train, mentor and provide supervision for staff in
pediatric HIV care and treatment, develop linkages to PMTCT, pediatric Counseling and testing services
and general health services for children to increase the number of children receiving HIV care and
treatment.
Additional activities that will be included with this funding are:
1) Develop sub- agreements to finance community organizations to implement patient follow up and provide
adherence support
2) Support establishment of "moonlight" ART Pilot site(s) to increase access to ARV treatment for
vulnerable populations (such as drug users and commercial sex workers), improving access and services
for these particular groups at selected sites in Maputo and Nacala (Nampula province).
This activity will be informed by results from a qualitative assessment (I-RARE) conducted in November
2007, providing information about needs and barriers to access for HIV counseling and testing, and ART for
HIV-infected high-risk-group populations. Community-based and CT activities that will contribute to
increased identification and referal of high-risk group members in need of services are described in other
parts of the plan. It will be of crucial importance for ART sites to be prepared and provide services that are
open and user-friendly from the perspective of this particular group.
3) Include funding for a Provincial Treatment Coordinator support for Inhambane Province - (includes office
costs, vehicle, fuel, maintenance, security, driver and recruitment of a Technical Advisor). This will allow
Columbia University/ICAP to provide province-wide support to the ART scale up in Inhambane, ensuring
provision of quality ART services as well as program reporting. Inhambane Province currently provides
approximately 5% of CU's total number of people enrolled on ART)
4) Follow up military personnel identified as HIV positive during the prevalence study and ensure they are
referred and enrolled into HIV/AIDS care and treatment services. This will include training nurses working at
military bases on follow up of patients receiving ART (under supervision of Military doctor), management of
opportunistic infections and treatment adherence.
5) Pilot a comprehensive HIV care and treatment program in the Civil Prison targeting men, women and
their children, guards, and their families. This intervention includes provision of HIV counseling and testing
(CT), risk reduction and behavior change interventions, PMTCT services for female inmates, screening and
treatment for Sexually Transmitted Diseases (STDs), TB and other Opportunistic Infections (OIs), and ART
services for eligible HIV-infected persons identified.
Once released from prison, HIV positive in-mates will be provided with referrals and assigned a case
manager to assure that they have been able to access care and treatment within the general community.
Funding to support this activity will be used to provide training for doctors, nurses and other health staff
working in the two selected pilot sites, as well as to ensure availability of necessary supplies; to support
program monitoring, a peer educator program and treatment support groups, disseminate IEC materials for
treatment literacy including PwP messages.
FY07:Follow up the military personnel identified as HIV positive during the prevalence study and make sure
they are all enrolled in HIV/AIDS treatment sites. Train nurses working at military bases on ART prescription
and identification of OIs. These nurses will be responsible to provide CT, collect the drugs for each ART
eligible soldier in his unit at the nearest treatment site, and assist them on how to take the drugs. To ensure
TB/HIV treatment adherence, they will be trained using already existing treatment adherence materials
including those being newly developed by Columbia University. The nurses will report to the military doctor
in each location.
Provincial TX Coordinator Support for Inhambane - office costs, vehicle, fuel, maintenance, security, driver
and Technical Advisor
Continuing Activity: 16276
16276 16276.08 HHS/Centers for Columbia 7403 3568.08 Track 1 ARV $13,825,000
Estimated amount of funding that is planned for Human Capacity Development $880,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $100,000
ICAP-MZ-Mozambique is committed to full and equitable access for HIV infected and exposed children into
HIV care and treatment services. Four main areas of specific pediatric focus have been identified for the
next year activities: 1) early identification of infected infants/children, 2) early initiation of treatment, 3)
quality of care delivery to children in care and 4) retention of patients into care and treatment.
At the end of June 2008 (PEPFAR report) ICAP supported Pediatric care and treatment at 40 sites in
Maputo City, Gaza Province, Inhambane Province, Nampula Province, and Zambezia Province including
two referral Hospitals for HIV infected children in Maputo and Nampula. Approximately 12,200 children were
enrolled in care and 3,000 are on ARVs (879- 30% in the age group 0-1y; 958-32% in the age group 2-4y;
1125- 38% in the age group 5-14y).
Of all patients enrolled at sites supported by ICAP-MZ approximately 8% are children. The target for next
year is to reach a proportion of 10% of children enrolled in care.
To achieve the target described above CU will continue to support HIV care and treatment services at the
two Pediatric ART reference Hospitals at Maputo and Nampula and at the other existing sites and will
expand pediatric services to 12 new more sites.
This support includes procurement of equipment, supplies and medication, support for strategic information
and local staff mentoring in management of pediatric HIV care and treatment by regular Clinical officer visits
and activities planned together with the Provincial directorate (DPS) in order to build capacity of the on site
Multidisciplinary team.
Training will also target Medical assistants according to MOH "task shifting" recommendations in order to
expand pediatric care to rural areas and health centres. Clinicians will offer regular mentoring of medical
assistants at sites and support the Provincial and District Health Directorate (DPS and DDS) to build
capacity in managing, planning and supervising the HIV Pediatric program linking HIV pediatric care to the
Mother and Child Health Provincial Program.
A Pediatric HIV Advisor will coordinate CU pediatric support for all CU-supported sites; two pediatricians will
support two focal provinces (Zambezia and Nampula) and four nurses will strengthen the link with the
PMTCT and MCH programs at provincial level.
Identification of infected children will be strengthened by implementation of routine Provider Initiated Testing
and Counseling offered to all children admitted in the Pediatric ward and accessing Pediatric care at any
entry point in 50% of the services CU is supporting (all central, provincial and rural hospital) according to the
MOH recommendations.
CU is also supporting Early Infant Diagnosis (EID) though PCR DBS in 16 PMTCT sites (Maputo city,
Inhambane, Nampula) and 20 HIV Clinic and infants follow up offering a minimum package of care (growth
and neurological development monitoring, CTX prophylaxis, OIs treatment, infant feeding counseling and
support,confirmatory test at 9-18 months).
EID program will be also supported by strengthening Lab capacity in managing PCR DBS samples/results,
supplies chain and distribution. Support to the Central Immunology Laboratory by a laboratory nurse
supporting the National EID logistics throughout the Country will continue and support to Provincial
Laboratories (Gaza, Inhambane, Nampula) will start. At provincial level, close supervision will be provided
by the lab advisor and cooperation between laboratory advisor, the provincial laboratory technician and the
provincial clinical advisor will be encouraged. A Lab M&E system, including computer supply, development
and training of an M&E package, will be implemented and continuously supervised by the Lab Advisor and
M&E advisor.
Retention of children into care and treatment services will be another main goal for year 2009, with a
particular focus on children not yet started on ARV treatment.
Activities to optimize adherence/retention in care include enhancing patient support by training MCH staff in
skills & quality of care with a focus on adherence monitoring & counseling, group management skills &
psychosocial support.
Follow up of children in care and on ARV will also be improve by strengthening Home based care activities
by creating partnership with local and international NGOs that are supporting peers-educators and home
based care activities.
CU will strengthen linkages between existing OVC care and support programs and clinical care.Working
through community-based organizations and other partners with programs targeting OVC and their families,
CU will ensure that OVC have access not only to HIV care and treatment as needed, but are also referred
to psychosocial support and food and economic assistance, where possible.
Efforts will also be done to asure provision of ITN, safe water and food support, through linkages with
comunity based organizations and other PEPFAR partners.
Advocacy at MOH level to focus on the children and adolescent age groups for the psychosocial component
of the HIV National program will continue and support in developing training curriculum and material on
pediatric/adolescent testing and counseling and disclosure will be provided.
Quality of care delivered to exposed infants followed up at CCR consultation will be supported by
strengthening the ongoing comprehensive strategy of linking PMTCT program and CCR services at the 36
existing sites (Maputo, Inhambane, Nampula) and at new 13 PMTCT/CCR sites (Zambezia and Gaza
Province).
Capacity building of existing staff and enrollment of new MCH nurses will be CU focus.
Strong linkages between CCR consultation and Pediatric HIV care & treatment services is critical to provide
more effective interventions for early diagnosed infants and start them on ARVs. CU will continue to
emphasize this comprehensive approach, building on MCH and PMTCT services, focusing on follow up of
exposed infants, offering care, early diagnosis tests and prompt referral to HIV Clinic.
Regular monitoring of quality of care delivery for children in care and on ARVs have been done for the main
Provincial and General Hospital supported by CU (Mavalane GH, Jose'Macamo GH, Military H, Inhambane
PH, Quelimane PH, Mocuba RH, Marrere GH, Xai Xai PH) implementing a Quality control tool, called
Activity Narrative: Pediatric Standard of Care (Ped SOC) adapted and adopted by the MOH. The regular implementation of
the tool together with MDT discussion of results, identification of obstacles and problem solving showed an
increase in quality care delivered to children and their families by that service. The plan for year 2009 is to
continue using the PED SOC at sites where is already well established and expand to 6 more sites (Gaza,
Zambezia, Inhambane) as a routine monitoring of the performance of the site in offering quality care to
children.
CU will continue to support monitoring and evaluation activities at sites and capacity will be created at DPS
and DDS level to monitor ongoing activities and results for the pediatric component of the program,
including regular evaluation of quality of service delivery (pediatric Standard Of Care and Pediatric HIV
QUAL).
Construction/Renovation
* Child Survival Activities
* Safe Motherhood
* TB
Estimated amount of funding that is planned for Human Capacity Development $30,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $15,000
Estimated amount of funding that is planned for Water $6,000
Table 3.3.10:
April09 Reprogramming: Increased $121,242.
This is a continuing activity.
ICAP-MZ-Mozambique is committed to full and equitable access for HIV infected children into HIV care and
treatment services.
Three main areas of specific pediatric focus have been identified for the next year activities: 1) early
initiation of treatment for infected infants and children, 2) quality of care delivery to children on ART and 3)
retention of patients into treatment.
two referral Hospitals for HIV infected children in Maputo and Nampula. Approximately 3,000 children are
on ARVs (879- 30% in the age group 0-1y; 958-32% in the age group 2-4y; 1125- 38% in the age group 5-
14y).
Of all patients on ART approximately 10% are children; the target for next year is to reach a proportion 11%
of children on ART.
expand pediatric services to 12 new sites.
and local staff mentoring in management of pediatric HIV care and treatment by regular clinical officer visits
and activities planned together with the Provincial directorate (DPS) in order to build capacity of the on-site
multidisciplinary team.
expand pediatric care to rural areas and health centres. Training will focus on the new MOH/WHO
guidelines for initiation of children on treatment in order to decrease morbidity and mortality including WHO
new staging. Clinicians will offer regular mentoring of medical assistants at sites and support the Provincial
and District Health Directorate (DPS and DDS) to build capacity in managing, planning and supervising the
HIV Pediatric program linking HIV pediatric care to the Mother and Child Health Provincial Program.
The plan is to strengthen EID at sites where it's already operational and expand it to 9 more sites continuing
training staff in collecting DNA via DBS.
more effective interventions for infants early diagnosed and start them on ARVs. CU will continue to
The referral system between the CCR and the ARV Clinic will be strengthened, especially for infected
infants that need early initiation according to new MOH and WHO guidelines, by up-dating staff on the new
guidelines and reinforcing the role of peer educator and activists in building this link. The expected
proportion of positive infants less than 12 months of age started on ART is 100% at all sites providing
ARVs; at the moment it varies from 15% to 50% depending on site and province.
and Counseling (PICT) offered to all children admitted in the Pediatric ward and improve access to ART.
Regular monitoring of quality of care delivery for children on ARV have been done for the main Provincial
and General Hospital supported by CU (Mavalane GH, Jose Macamo GH, Military H, Inhambane PH,
Quelimane PH, Mocuba RH, Marrere GH, Xai Xai PH) implementing a Quality control tool, called Pediatric
Standard of Care (Ped SOC) adapted and adopted by the MOH. The regular implementation of the tool
together with Multi-disciplinary Team (MDT) discussion of results, identification of obstacles and problem
solving showed an increase in quality care delivered to children and their families by that service. The plan
for year 2009 is to continue using the PED SOC at sites where is already well established and expand to 6
more sites (Gaza, Zambezia, Inhambane) as a routine monitoring of the performance of the site in offering
quality care to children.
including regular evaluation of quality of service delivery (Pediatric Standard Of Care and Pediatric HIV
The overall retention of patients into ART care is around 85%, but more specific date on the pediatric
population are needed.
Retention of children into care and treatment services will be another main goal for year 2009; activities to
optimize adherence/retention in care include enhancing patient support by training MCH staff in skills &
quality of care with a focus on adherence monitoring & counseling, group management skills & psychosocial
support.
Follow up of children on ARV will also be improve by strengthening Home-based care activities by creating
partnership with local and international NGOs that are supporting peer educators and home based care
activities.
pediatric disclosure will be provided.
Table 3.3.11:
Continuing Activity:
All PEPFAR clinical partners will support core TB/HIV collaborative activities in accordance with the WHO
Interim Policy (2004) in all districts and facilities that are supported for other clinical activities. This includes
(1) active participation in TB/HIV coordinating mechanisms at national, provincial, and local level, supporting
MOH TB/HIV planning and supervisory activities, and assisting with TB/HIV monitoring and evaluation
activities. In addition, clinical partners assist national TB programs with activities to reduce the burden of
TB in HIV-infected persons under their care through comprehensive and routine TB screening, isoniazid
preventive therapy (IPT) for those without symptoms or contraindications, and facility-level infection control
measures. Finally, all clinical partners support activities by the TB program to reduce the burden of HIV
through provider-initiated counseling and testing (PICT) for all TB patients (including children),
cotrimoxazole preventive therapy (CPT) (provided in TB clinics) for all TB patients, and referrals or on-site
provision of ART to coinfected patients. In accordance with new WHO guidance and with experience in
Mozambique that some activities (e.g. HIV-testing, CPT and ART) have advanced faster than others, all
partners will be encouraged to strengthen activities related to the 3 I's: intensified TB case finding, IPT, and
infection control. This includes support for routine (and WHO and NTP-recommended) contact tracing.
Partner-specific activities are described below.
At Columbia university- supported sites the Columbia university- staff has been working to provide a
package of TB/HIV integrated activities according who recommended TB/HIV collaborative activities, the
Mozambican MOH recommendations and Mozambican TB strategic plan.
Columbia university will continue to implement TB/HIV collaborative activities and to emphasize the
implementation of the "three I's": intensified case finding (ICF), Isoniazid prophylaxis (IPT) and infection
control (IC). Although the implementation of the "three I's" should be owned by HIV program, there is a
need to strengthen the TB treatment sites support where the implementing partners are working.
Columbia University will continue to support provider-initiated HIV counseling and testing for TB patients
who arrive at the TB clinics linked to art clinic with unknown HIV status, expanding it also at other peripheral
TB units and strengthen referral system with ART clinics.
This will include provincial refresh training on HIV counseling & testing for TB nurses, supervision &
mentoring, implementation of M&E and referral systems, TB/HIV staff, supplies and equipments.
Columbia university will strengthen TB intensified case finding among HIV patients enrolled in ART
supported facilities -through the TB screening tool developed by ICAP and recently adopted by the national
TB program - as well as the referral system of co-infected patients and comprehensive care and follow-up of
co-infected patients. The use of the TB screening tool will be improved in terms of regularity of its use, the
way of patient's information is recorded, quality of diagnostic process, timeless and completeness.
This will be through training staff, continuous supervision/mentoring, strengthening of the M&E systems,
TB/HIV staff, supplies and equipments.
Provincial update training on clinical management of TB/HIV for clinical staff, including clinical officers
("técnicos de medicina") will be organized.
Furthermore Columbia University will expand TB active case finding in pediatric HIV patients through the
implementation of the adopted WHO "guidance for national tuberculosis programmes in the management of
tuberculosis in children", training and technical assistance.
Both the TB program and the HIV program should be an entry point for the prompt identification and the
best possible case-management of co-infected patients.
Columbia University has been promoting functional and scalable linkages and referral systems between TB
and HIV services for patients with known or suspected co-infection.
Cotrimoxazole prophylaxis is provided for co-infected patients at both TB and HIV services and CU will
promote its correct and regular implementation at supported sites.
TB prevention and infection control also will be promoted at supported facilities through promotion of IPT for
eligible HIV patients and through administrative-personal- environment basic measures to reduce the risk of
TB infection transmission.
IPT is recommended and promoted by the national TB program but is not regularly and completely
implemented yet. This is due to the clinicians' concern in selecting eligible patients and in ensuring their
regular follow up.
Moreover, national stock out of Isoniazid led to a delay in the implementation of the activity nationwide.
At Columbia university-supported facilities IPT has been progressively implemented and it will be expanded
and strengthened through training staff, continuous supervision/mentoring, strategies to truck patients and
improve their adherence and follow up.
At national level CU has been collaborating with the national TB program and the national TB/HIV Task
Force through technical assistance, regular participation to the meetings, review of guidelines and manuals,
development of tools and forms.
Support and technical assistance at national level will be continued as well as logistical support for revising,
translating and reproducing manuals, tools and any instruments for TB/HIV integration (that includes a
"pocket guide"on TB/HIV collaborative activities based on the national recommendations) and regular
participation to meetings of the TB/HIV Task Force to enhance partnerships and coordination of TB/HIV
Support health system strengthening and collaboration between programs from national level to service
delivery level will be offered through:
- Support provincial health directorates in organizing provincial meetings on TB/HIV integration for TB staff
and HIV representative staff from all the districts;
- support integrated supervision of TB/HIV activities and DOTS at provincial and district level;
- support regional training on TB program management for key TB staff;
- close collaboration of CU staff and the provincial and district health directorates
Continuing Activity: 16282
16282 5201.08 HHS/Centers for Columbia 7403 3568.08 Track 1 ARV $875,000
8565 5201.07 HHS/Centers for Columbia 4878 3568.07 Track 1 ARV $1,100,000
5201 5201.06 HHS/Centers for Columbia 3567 3567.06 UTAP $563,000
Estimated amount of funding that is planned for Human Capacity Development $195,000
Table 3.3.12:
To date Columbia University (CU) has supported HIV Care and Treatment in districts in Zambezia, Nampula
and Gaza Provinces as well as in Maputo City. CU provides supervision, clinical mentoring, and technical
assistance to include training, infrastructure development, capacity building to Provincial Health Directorates
(DPS). For FY09 PEPFAR Mozambique team has undergone a clinical partner rationalization exercise in
order to streamline support to cover all clinical services in a whole district by one clinical care partner. For
FY09 CU will receive budget allocations to cover facility based counseling and testing interventions -
Provider Initiated Counseling and Testing and CT in Health. CU will assume and continue CT services in
sites supported to other USG partners and include PICT in all sites where treatment is being implemented.
CU will continue to support activities related to C&T and disclosure for children in partnership with CDC and
Mozambican Ministry of Health and provider initiative counseling and testing (PICT) strategy. For the COP
09 CU will finalize training material, and will support national TOT and provincial trainings.
As a new programatic area CU will hire one C&T technical advisor to be based in Maputo headquarter to
oversee all C&T activities and operationalize a national plan that includes PICT and VCT according to MoH
guidance. To achieve its goals CU will take advantage of its adherence and psycho social support staff
already based in the provinces (Maputo City, Gaza, Inhambane, Zambezia and Nampula Province), and
peer educators groups, support groups and health providers in a comprehensive package of psycho social
support. The pshycho social structure already existing will serve as a backbone of counseling and testing
related activities in all CU supported districts.
CU will use subagreements established with Pathfinder International and TDB NGO with Track 1.0 funds to
identify and refer to C&T household/family members and potential new HIV infected individuals.
Aiming the objectives of the transition plan CU designed a plan to take over (including human resources,
technical assistance, training and supervision on a monthly bases) the exisiting VCT according to the
following plan:
1. first quarter - 8 sites
2. second quarter - plus 10 sites
3. third quarter - plus 13 sites
4. fourth quarter - plus 15 sites
In addition to that, CU will enhance providers skills to conduct PICT in 4 CU supported sites, in special for
pediatric and adults wards/outpatients units through mentorship system in Nampula and Maputo City or
Zambezia Province. Anticipated components of the mentorship system will include assessing each site's
set up for PITC implementation and supply chain management and interacting with the trained and
untrained PITC health care workers in different departments where PITC is being implemented. Mentorship
will also involve observation of pretest information and post test counseling sessions guided by a checklist,
mentoring of specified skills especially on testing and counseling procedures and observing procedures in
conducting HIV testing using national testing algorithm. The final area of emphasis will be ensuring that
quality PITC data is recorded properly in HIV testing and counseling registers."
Continuing Activity: 16274
16274 16274.08 HHS/Centers for Columbia 7403 3568.08 Track 1 ARV $80,000
Table 3.3.14:
THIS IS A NEW ACTIVITY
Laboratory services are an integral service component to support optimal care and treatment to HIV
patients. Columbia University (ICAP) has standardized laboratory services in different sites throughout the
Provinces in which we work. The main activity in the area of lab strengthening has been to assess
adequacy of laboratory sites and to adjust working environments to optimize laboratory services and
practices within available resources. This has included laboratory renovations in some districts to ensure
that laboratory infrastructure was such that new equipment, provided by APHL, could be placed.
ACTIVITIES AND EXPECTED RESULTS
Treatment Program Lab Advisor: The laboratory Technical Advisor based at the ICAP National Office level
will be responsible for overseeing the laboratory component of the PMTCT and Care and Treatment
Program within the ICAP supported districts and supporting ICAP staff in providing supervision of laboratory
services within the program. In addition, (s)he will function as a counterpart for the Laboratory Technical
Advisor based in DPS of each province.
The Laboratory Advisor will liaise and coordinate activities related to laboratory services with NGO's and
partners assisting the MOH in laboratory issues such as Clinton Foundation, SCMS, and APHL. The
Laboratory Advisor will identify weaknesses in laboratory processes, procedures, and logistics, propose
adequate strategies for improvement, and contribute to a plan towards building capacities at national,
provincial and district levels. He will give specific attention to realities and problems emanating from field
level, communicate needs and priorities identified and channel solutions to adequate forum and authorities.
The work of the laboratory advisor shall be integrated with on-going or new MOH national and provincial
laboratory activities and policies. (S)He shall also respond to priorities identified by ICAP teams or other
direct implementers in the Province. Overall, the ICAP Laboratory Technical Advisor will improve laboratory
services as a crucial component of quality care in the provinces supported by ICAP.
Provincial Lab Advisors: The MOH has requested that USG Partners support 4 technical advisor positions
within the Provincial Directorate for Health Offices (DPS) each of the 11 Provinces. One of these technical
advisors is a Laboratory Technical Advisor. As lead Clinical Partner in three Provinces, ICAP will support
salary and benefits for three of the Provincial lab technical advisors. Provincial Lab Technical Advisors will
report directly to the DPS and will oversee laboratory activities across the Province, irrespective of what, if
any, partner support is given. The Provincial level Lab Tech Advisors will create a link between the central
level Laboratory Section and the Province to facilitate communication and information flow and to implement
policies and practices established by central level MOH. Advisors will work with implementing partners,
DPS, and other donors to strengthen laboratory commodity logistics, quality assurance, monitoring and
evaluation of lab services, and human capacity development.
Total Budget: $340,000 (85,000 each for 4 technical advisors)
New/Continuing Activity: New Activity
Estimated amount of funding that is planned for Human Capacity Development $170,000
Table 3.3.16:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
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 8639.08 in COP 08 (Provincial M&E Officers).
This is related to the following activities in COP 09:
Ministry of Health has placed increasing focus on strengthening human and technical resources at the
provincial level to improve the coordination and delivery of services in the province. In FY08, Ministry of
Health developed a standard set of technical advisor positions to be placed at the Provincial level; these
four positions included advisors in Clinical Care, Laboratory, Pharmacy, and Monitoring and Evaluation.
USG was asked to assist with the funding and recruitment of these positions at the provincial level. The
primary partner responsible for providing technical assistance in the area of clinical services in a province
will also be responsible for the recruitment and support of the four technical advisor positions, including this
Monitoring and Evaluation Technical Advisor position.
The M&E Provincial Advisor will provide support in the cooridnation of routine activities related to monitoring
and evaluation at the Provincial Directorate of Health, giving priority to endemic diseases, including HIV.
This advisor will help to reinforce adn support the implementation of the decentralization of HIV services
including related data collection systems. S/he will provide leadership in the supervision and management
of data to ensure the quality of data at the district and site level, help to strengthen the flow of data to the
district, provincial, and central levels. Additionally this person will support the Provincial Directorate of
Health in the analysis and dissemination of data (for example, to the site level, Ministry of Health, and
partners.) This person will sit within the Provincial Department of Planning and Cooperation at the
Provincial Directorate of Health.
Columbia University/ICAP has been asked to place 3 M&E Advisor in Maputo City, Nampula, and
Inhambane as part of their overall support to clinical services in these Provinces.
Table 3.3.17:
The Ministry of Health uses an MS Access-based database (Modulo Basico) to collect, manage, and report
routine (monthly) aggregate facility level information at the provincial and national level. This program was
developed for Mozambique by an expatriate programmer in 2004 and has been supported by the
programmer who is seconded to the Ministry of Health's Department of Health Information since then. This
position has been supported by funds from another donor, but these funds are being discontinued. USG
has agreed to provide salary support for the continuation of this position, which is being competed in
October 2008, to ensure continued basic support of this critical system.
A key focus of this technical advisor is capacity building and systems strengthening within the Department
of Health Information. The advisor will actively participate in the training of his Mozambican counterparts, at
all levels of the Health System of the Republic of Mozambique and will assist with the integration of National
Health Information System with other diverse vertical programs.
Discussions are in progress with the Ministry of Health to identify a specific individual to work on modulo
basico. Mentorship of this Mozambican counterpart would be a prioirity for PEPFAR Mozambique.
This advisor will participate in a different but related activity (currently funded with existing funds through I-
TECH) to develop recommendations for modifications and enhancements to the Modulo Basico system. It
is expected that this advisor would play a key role helping to prioritize enhancements that are needed in the
system as well as to participate in the implementation of these enhancements.
This is listed as a new activity in COP 09 but was funded in previous COPs under a different program area.
The Ministry of Health's Department of Health Information (DIS) is responsible for the overall coordination
and strengthening of health information systems in the Ministry of Health. Currently, DIS faces a dire
shortage of human resources in terms of number of qualified staff needed to carry out key tasks. Since
2007, CDC has funded a technical advisor secunded to the MOH's DIS to assist with strategic planning and
implementation of key activities in the DIS annual workplan.
of Health Information. The advisor will actively participate in the training of Mozambican counterparts, at all
levels of the Health System of the Republic of Mozambique and will assist with the integration of National
April09 Reprogramming: Increased $331,465.
This is a new activity.
This activity will contribute to strengthening health system at the provincial level with the goal of developing
a more sustainable health care system.
The Ministry of Health is vitally interested in developing a cadre of technical advisors, preferably
Mozambicans, where possible. The USG shares this goal and will be working with all treatment partners to
develop ways of preparing Mozambicans for these positions such as on-the-job mentoring and education. 4
Pharmacy advisors will be hired by Columbia University will support Provincial and District Health
Directorates to create capacity in the area of drugs and consumables. Advisors will work closely with DPS
parmacy technicians, warehouses incharges and HIV/TB/Malaria coordinators in order to avoid stock outs
and to reinforce the links between facilities, provincial and central level. Emhasis will be put on forecasting
capacity.
:In COP09 will for the first time treat infrastructure development as a discrete rather than embedded
program area, with appropriate budgetary provision, and a program structure designed to improve the
speed, quality, and cost effectiveness of implementation. Two mechanisms will be employed to deal with
large- and medium-scale construction. Treatment partners will be relieved of the burden of having to
manage activities that are somewhat removed from their primary fields of excellence. However there will
still be cases where it is more efficient and appropriate for these partners to organize minor building repairs
and improvements locally rather than through a central mechanism. CU will support minor renovations of
pharmacy areas at new facilities where the assessment will show the need.
CU plans funds to support salary for freshly graduated professionals to cover the period between end of
studies and the entry in the National Health Service. Provinces where CU will be the lead partner will be
prioritized for this activity and this will anyway be done according to the needs and requests of MoH. It is
expected that this gap year funding will retain graduates at their work while the national health services and
other ministeries finalize their recruitment process to become those new health workers as public servants
integrated in the national health services. An estimate of 15-20 professionals could be supported through
this activity. In calendar year 2009, it is anticipated that the MOH will institute salary reform and therefore
raise salaries so the number of staff supported may change.
Given the urgent need for increasing the number health care workers at all levels, PEPFAR funds will be
used to pay for course fees associated with attending a pre-service institution. The goal of this activity is to
both increase the production of health care workers and lessen the numbers who drop out due to financial
constraints. CU will support about sixty students for the course of Health Technician and Nurse in Nampula
Province at Instituto de Ciencias da Saude. The planned amount of 200,000 USD will cover the first 12
months of the courses for a total of 90 students.
CU will offer Counseling module (ATS and Adhrence) for pre-service training to health technician, basic
nurse and preventive medicine technician (30 health tecnicians and 30 nurses) at Instituto de Ciências da
Saúde da Zambézia
CU will work with districts to health managment teams to build on planning and managment capacity.
CU will support coordination activities at District level with the aim of widening the support from site to
district support. This activity will have particular emphasis in Provinces were CU will be the lead partner
(about 20 districts). This will include a broad range of activities like technical and financial support for
integrated supervisions, planning exercises, managment meetings and district health information systems.
Products/deliverables
It is expected to have 30 professionals trained in CT.
90 students will be supported for the first year the three courses for Health technician and Nurses.
10 Health facilities will receive rehabilitation according to DPS priorities for a total amount of 450,000 USD
15-20 professional receive salary up to 12 months
4 Pharmacy Technical Advisor for Provincial Health Directorate hired
Estimated amount of funding that is planned for Human Capacity Development $1,097,984
Estimated amount of funding that is planned for Education $300,000
Table 3.3.18:
