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 IS A NEW ACTIVITY
Until October 2008, Early Infant Diagnosis (EID) capacity was limited to a single reference laboratory (INS)
in the capital city of Maputo, in the southernmost region of the country. Testing capacity was expanded in
October 2008, when a second laboratory in the Northern region of the country was opened. Dried Blood
Spot specimens from every Province in the country are referred to one or the other of these laboratories for
testing. As a result, long delays often occur in getting test results back to health facilities for communication
to patients and follow up. To improve the timeliness and access to EID, FY09 funds will support expansion
of EID to an additional laboratory in the Central region of the country. Funding to APHL will support training
and certification of laboratory technical staff to perform DNA PCR for EID and to manage specimens coming
into the laboratory and results being sent out from the laboratory. Funding will also support participation of
the new site in the external quality assurance program, managed from the INS laboratory, as well as
periodic sites visits, by INS laboratory staff, to monitor testing practices and provide follow-up refresher
training. Reagent-rental agreements will be the mechanism to procure equipment for the new laboratory
and Clinton Foundation-UNITAID will continue to provide EID reagent support through 2010.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $25,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.11:
THIS IS A CONTINUING ACTIVITY. This activity is linked to lab capacity building activities implemented by
ASM, ASCP, SCMS, MoH, and TBD South to South partner.
The Association for Public Health Laboratories has been supporting the Ministry of Health's (MoH) objective
to build human capacity to support expansion of laboratory services in Mozambique through implementation
of the National Strategic Plan for Laboratory. With PEPFAR support, APHL has been instrumental in
establishing and expanding the CD4 Network to increase access to diagnostic testing for all patients on
ART. To date, all 11 provinces in Mozambique have CD4 capacity and all have received PEPFAR support
to initiate and maintain this testing service. In collaboration with the National Immunology Reference
Laboratory (INS), APHL has supported the EQA program for CD4 testing across the entire network,
including support of site supervision conducted by INS staff. APHL support to INS has also enabled INS to
take the lead in the development and dissemination of CD4 testing SOPs and of both basic and advanced
CD4 training of MoH staff conducting CD4 testing across the network. In addition, APHL has assisted in
procurement of equipment, supplies and reagents (including internal quality controls) for clinical chemistry
and hematology. In collaboration with MoH and PEPFAR treatment partners, APHL supports technical
training for biochemistry and hematology, initial and refresher trainings, as well as dissemination of SOPs to
perform these tests. However, to date, there is no EQA program for these tests.
With PEPFAR funds, APHL has played an integral role in provision of technical assistance, to MoH and
Implementing Partners, for the physical infrastructure design of reference, clinical and training laboratories.
APHL has provided guidance on appropriate equipment for placement and has conducted site assessments
prior to placement of PEPFAR procured laboratory equipment in either clinical or training laboratories.
APHL has played a lead role in laboratory training activities in Mozambique. They have served as the lead
implementing partner for the provision of in-service technical training for laboratory staff to improve their
skills in CD4, biochemistry, and hematology testing. APHL conducts ongoing site supervision to PEPFAR
supported laboratory sites and provides on the job training in equipment maintenance, laboratory inventory
management, biosafety, and record keeping. APHL has conducted laboratory management training
workshops for Provincial Laboratory Supervisors which focuses on leadership, supervision, communication
and time management skills. Also, at the request of the MoH and to fill the critical shortage of higher level
laboratory technical staff, APHL has developed and implemented a novel training approach whereby
Mozambican Biologists working within the MoH are capacitated to serve in clinical laboratories across the
country. During a 6 month "mini medical technologists training program", Biologists are equipped to:
understand the theoretical aspects of HIV disease monitoring tests, perform HIV disease monitoring
diagnostic testing, adhere to quality assurance and biosafety practices, and manage laboratory information.
This training is implemented through both didactic and practical training in highly functioning institutions in
the United States which adhere to best practices and international standards of performance. As a result,
Biologists bring back to Mozambique a vision of the excellence they aspire to achieve within the clinical
laboratory network and the motivation to actively engage their administration, colleagues, and subordinates
to join in the effort to elevate the laboratory network in Mozambique to a higher level.
With PEPFAR funding in previous years, APHL has been instrumental in building the Laboratory Information
System (LIS) for laboratories across the network. To date, APHL has successfully implemented the first
four of a network of electronic LISs with the goal of implementing electronic LISs in each of the three
Central Hospitals, 11 Provincial Hospital Laboratories, and the INS. For laboratories below the Provincial
level, an improved paper-based system was developed in collaboration with the MoH (Laboratory Section
and Department of Health Information Systems). These LIS systems are designed to be complementary
and to collect information which is relevant for monitoring and evaluation of the laboratory services capacity
at site level, provincial level, and national level.
In FY09 APHL activities will continue to focus on training, laboratory capacity building and systems
strengthening at central and provincial level in line with the National Strategic Plan for Laboratory. APHL‘s
goal is to support laboratory strengthening activities to enable the national laboratory system to provide
accessible and quality testing services that produce timely and accurate results. To achieve this APHL will
implement the following activities:
1. Expansion of the LIS.
With FY08 funding, an expanded version of the eLIS software, which provides ability to manage results from
a full menu of diagnostic tests that are performed in Mozambique, will be piloted. In FY09, eLIS will be
placed in two additional sites, bringing the total number of sites with eLIS to six. The expanded eLIS
software, once piloted, will be implemented at all six sites with eLIS. Installation of additional eLIS systems
as well as new software will be accompanied by appropriate on-site training to ensure relevant staff has the
necessary capacity to fully utilize and manage the system. In addition, APHL will implement a central
database for the eLIS within the Laboratory Section at the Ministry of Health to allow for improved
monitoring and evaluation of the laboratory network by the Central level laboratory section of MoH. These
data will also be instrumental in improving the forecasting and supply planning of laboratory commodities
across the lab network as accurate data on number of tests performed by site will be readily available. This
activity will be implemented in close collaboration with SCMS to ensure standardized techniques in
laboratory commodity supply planning. With FY08 funds, APHL will pilot the enhanced paper-based LIS in
six representative labs across the network. In FY2009, finalized and MoH-approved paper-based LIS forms
will be printed and distributed to all labs across the network. Training on use of forms and follow-up
monitoring and evaluation of their use, will be conducted to ensure the utility of the LIS is maximized.
2. Expansion of the specimen referral and tracking system.
The specimen tracking and referral system piloted in FY08 in Maputo will be expanded to the provinces.
This activity will be done in collaboration with Clinton Foundation, as they are interested in strengthening
specimen referral and transport for early infant diagnosis. In Mozambique, each Province manages
specimen referral networks independently of Central Level and each has developed a unique system that
takes advantage of available resources in the Province. However, the systems are weak and subject to
frequent interruptions. FY09 funds to APHL will be used to assess specimen referral networks by Province
Activity Narrative: in collaboration with Provincial MoH, Clinton Foundation, and Treatment Partners in the given Province.
Recommendations which utilize the available resources in the Province will be developed and implemented.
To ensure sustainability, reliance on courier contracts, which are funded by PEPFAR, will be avoided and
use of transportation networks already working in the Province will be maximized.
3. Strengthening of the national quality management system.
FY09 funds will be used to support technical assistance to MoH to develop a National Laboratory Quality
Assurance Plan, in accordance to the National Strategic Plan for Laboratory. To date, Mozambique does
not have a culture of quality regarding laboratory diagnostic services and lacks focal points at any level of
the laboratory network to implement and oversee a quality assurance program. Further more, the
Laboratory section within the MoH lacks staff trained in quality management. With FY09 funds, APHL will
support advanced training for the national quality assurance manager, to be appointed by the MoH. It is
likely that this training will take place in the U.S. such that the Quality Manager will have the opportunity to
observe and understand the key factors to managing a functional Quality Assurance Program for a large
laboratory network. He/She will learn how to develop and use tools, policies, and procedures to implement
and manage a National Quality Assurance Program. As a follow up to training in the U.S., short term
technical assistance by consultants (proposed to be Quality Manager from State Public Health Laboratory)
will be given to the MoH Quality Manager to ensure knowledge can be translated and applied to the
Mozambican lab network. FY09 funds to APHL will also support quality assurance training at the Provincial
level, as the MoH intends to identify quality managers in each Province to serve as the link Central Level
Quality Manager and manage the implementation of quality assurance policies and practices with the labs
in the Province
4. Supporting human capacity building.
FY 08 funds were used to train 12 in hematology, biochemistry, immunology, microbiology, and molecular
biology in the U.S. (Miami Dade College, Medical Technology Program). In FY09, APHL will support
specialized, short-term training for these biologists with the expectation that these individuals will become
focal points within the Provinces for quality assurance, biochemistry, hematology, immunology, and
molecular biology. APHL will coordinate with ASM to provide specialized training for one or more of these
Biologists in the area of microbiology, as part of the ongoing process to strengthen microbiology capacity
beyond Central Level. To build sustainability and increase the impact of this investment, a mentorship
program will be established whereby the trained Mozambican Biologist will spend up to three months
working with staff at rural and district hospital laboratories to improve the quality of testing services at these
levels. These activities will be coordinated by APHL and will assure integration with other laboratory partner
activities. In an effort to build human capacity through improved pre-service training, APHL used FY08
funds to assess the needs of a large Regional Health Science Training Institute in Nampula. With FY09
funds, APHL will rehabilitate and equip this training laboratory. To ensure faculty teaching in this training
laboratory have the necessary capacity to train on new and upgraded equipment, APHL will support short-
term trainings for faculty on these new and/or upgraded technologies. Prior to the PEPFAR investment in
the area, lab trainees would have their first hands-on experiences in the Provincial Clinical Laboratories.
With fully equipped training labs and capacitated faculty, students will have the opportunity to gain practical
experience before going to the Clinical Labs for additional practical training. This approach both improves
the quality of training and relieves the already overburdened Provincial Lab staff of basic training
responsibilities.
5. Support to the National Immunology Reference Lab (INS).
With FY09 funds, APHL will continue to support the expansion of quality assurance programs that are
currently being managed by the INS (CD4, EID, and HIV rapid test). APHL will support the INS to increase
the number of laboratory sites participating in EQA for HIV Rapid Testing, EID, and CD4 testing. To
achieve this expansion in EQA for HIV Rapid Testing, management of the program will have to be
decentralized. APHL will provide support to INS, in coordination with South to South TBD Partner, to
accomplish decentralization. This will include training for staff at Provincial level to manage the program,
support for distribution of panels throughout the Province, and collection of results.
APHL will receive FY09 funding in amount of $74,606 within the PDTX program area to support training and
logistics of Early Infant Diagnosis.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13188
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13188 5184.08 HHS/Centers for Association of 6407 3576.08 Technical $4,469,600
Disease Control & Public Health Assistance
Prevention Laboratories
8532 5184.07 HHS/Centers for Association of 4874 3576.07 Technical $5,347,122
5184 5184.06 HHS/Centers for Association of 3576 3576.06 Technical $3,133,000
Estimated amount of funding that is planned for Human Capacity Development $500,000
Table 3.3.16:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: (No new funds for FY09)
Activities 1), 2) and 3) below are in progress; dollar amounts allocated to each subactivity have been
removed. No additional funding is requested for this activity in COP09.
The remainder of this narrative is unchanged since COP08.
This activity is comprised of a number of subactivities. These include:
1) Procurement of laboratory tests, supplies and equipment for ART resistance monitoring
2) Procurement of tests, medicines, and sample collection and processing supplies and equipment for
Sentinel Surveillance
3) Procurement of laboratory tests, and sample collection and processing supplies and equipment for an
AIDS indicator survey
For ART monitoring one MOH-supported treatment site will be selected to pilot drug resistance monitoring
in a pediatric or adult cohort. Expected sample size is 100 patients, for whom baseline data will be
collected. Routinely-collected blood samples will be used for preparing baseline and 12 month genotyping
and viral load samples. Funds will cover procuring sample collection supplies and equipment. This is
related to activities 12267.08 and 8639.08.
This activity is associated with Mozambique's SI five year strategy to technically and financially support
surveillance to monitor HIV/AIDS-related illnesses, understand the behaviors that influence transmission,
improve access to and use of care and treatment services, strengthen the effectiveness of program
activities, and ensure a supportive environment for USG efforts. This is related to activities 10211.08 and
8639.08.
The Ministry of Health, in coordination with donor and technical assistant partners, began implementing
routine HIV/AIDS sentinel surveillance among pregnant women in 1998 in 10 sites. In 2007 during the latest
round, sentinel surveillance was conducted at 36 sites throughout the country and dry blood spot (DBS)
technology, BED incidence assays, and threshold ARV resistance monitoring were introduced. Data from
the sentinel surveillance round are used to describe the current burden of disease among pregnant women
and to produce estimates of the burden and impact of HIV/AIDS in the country and to monitor trends in
disease over time. Sentinel surveillance data are the cornerstone of allocating resources in the country as
well and are currently the national source for HIV prevalence estimates. For example, data are used to
determine priority areas for opening new treatment sites and focusing prevention efforts.
Since 2001, CDC has provided complete financial and technical support for sentinel surveillance activities in
Mozambique. In 2008, funds will be used to procure sample collection equipment and supplies, sample
processing equipment and supplies, and test kits necessary to conduct sentinel surveillance.
The only source of nationally-representative HIV indicator data in Mozambique to date was collected during
the 2003 DHS. In order for the US Census Bureau to be able to estimate the number of infections averted,
a key element of the 2-7-10 goals, a second HIV indicator data point is required by mid 2009. In addition,
as of yet no nationally-representative HIV serosurvey has been performed in Mozambique. While both of
these needs could be met by performing another DHS, due to the recent population census, upcoming
elections, and competing survey priorities the National Statistics Institute (INE) has indicated that they will
not conduct a DHS until 2010. This is related to activity 10211.08. Early funding for this subactivity is being
requested since the procurement must begin by April.
Continuing Activity: 15916
15916 15916.08 HHS/Centers for Association of 6407 3576.08 Technical $860,000
Table 3.3.17:
