The USG through the Department of Defense (DOD) will continue funding HIV related international and national courses for military health care providers. This activity focuses on developing the capacity of health providers responsible for ARV roll-out at Military Hospitals because an effective response to the HIV epidemic requires expertise, experience, and training in the prevention and treatment of people infected with HIV. This Implementing Mechanism is linked to the Goal 3 of the Partnership Framework which aims to strengthen the Mozambican health system, including human resources for health.

Therefore, some military doctors, nurses, psychologists and laboratory technicians will be trained in San Diego - California through the Military International HIV Training Program (MIHTP) which is a collaboration of the Naval Medical Center San Diego (NMCSD), the University of California & San Diego (UCSD) and San Diego State University (SDSU). NHRC provides operational support through DHAPP. The MIHTP provides training in HIV related patient management, epidemiology, and public health for medical military personnel actively caring for HIV infected patients. MIHTP top priority is to train key medical personnel (clinicians in practice) both in San Diego and abroad with the goal of transferring appropriate knowledge and technology to each country. The training programs and projects are developed in collaboration with each military organization to meet specific needs. Emphasis is placed on training, consultation, and operational support for prevention and clinical management of HIV and its complications as well as courses in epidemiological surveillance and laboratory diagnosis from a clinical physician perspective. A large emphasis is placed on the experiential part of the program to understand the military's policies and procedures regarding service members with HIV.

Other medical staff will continue attending training courses at the Infectious Diseases Institute (IDI) on the campus of Makerere University, Kampala, Uganda. The primary goals of the training program in Uganda are to:

1) Review the latest HIV diagnostic and treatment approaches; 2) Discuss major issues concerning comprehensive HIV care; 3) Discuss military-specific issues related to HIV care; 4) Enhance the clinical skills of practitioners dealing with patients who are infected with HIV and associated illnesses. 5) Provide up to date laboratory techniques (diagnosis, quality control, monitoring and evaluation, etc)

These goals will be accomplished through featured expert speakers on a range of HIV topics, interactive assignments, and practical demonstrations. The lectures will be presented by faculty from Makerere University as well as one international trainer from the Infectious Diseases Society of America. The method of instruction will include a combination of lectures, case discussions, journal clubs, and clinical experience. Lectures will be delivered in a classroom setting to the group as a whole, followed by inpatient and outpatient clinical sessions that will include bedside teaching rounds, an overview of systematic HIV patient care and management, and exposure to community-based HIV care and prevention programs. These trainings provided a practical experience on how to deal with HIV cases within the armed forces, maintaining the confidentiality of one's HIV status and supporting the patient's willingness to disclose it to fellow soldiers and/or family members. It was found that after returning from these trainings, the people trained are motivated and in general they make critical changes on their programs improving it based on the knowledge acquired. With the introduction of MC interventions at military highly populated sites, part of the funding will be spent on training clinical staff which will be working on this new intervention within the military population. There are also plans for partnering with Brazilian Universities and offer trainings locally to take advantage of the language, reduce the costs and increase the number of staff to be trained. This makes this implementing mechanism a very cost effective one.

With the increasing number of military health facilities being rehabilitated, more doctors will be relocated to remote areas to DOD-supported military health facilities. Trainings are designed for doctors, nurses and psychologists and will include subjects related to male circumcision interventions for HIV prevention, HIV/AIDS care and treatment, counseling techniques, patient tracking systems, etc. Military doctors will visit countries where MC service delivery is up and running and will receive theoretical and practical training. These trainings will also include practical exercises (local anesthesia administration, skin removal and stitch techniques) and site visits which it are planned to be at military units implementing MC interventions. The USG will ensure that funds are also spent in capacity building for Military physicians on areas such as STI Syndromic Management and clinical management of HIV/AIDS, integration of STI counseling into clinical practice, establishment of HIV/AIDS prevention and care units, collaboration and networking with home - based care and support groups, etc.

The psychologists will be trained in counseling skills as an essential component of their ongoing management of HIV patients (military and civilians) because, as is known, in the general practice management of HIV patients, there is a significant component of psychosocial issues requiring specific HIV and general counseling skills. The format and content of the course will effectively enable General Practitioners and Psychologists to develop the confidence and skills necessary for this counseling role. It will be their responsibility to clearly inform, counsel and support patients about many sensitive issues such as disclosure of HIV status, pregnancy and HIV, positive living, the responsibility for not infecting others, etc.