The International Center for AIDS Care and Treatment Programs of Columbia University, Mailman School of Public supports HIV services in Maputo city, Gaza, Inhambane, Nampula and Zambezia provinces. Columbia is the lead USG clinical partner in Maputo city, Inhambane, and Nampula province. By FY2009 , Columbia had expanded support to 87 ANC sites providing PMTCT services to 6,596 pregnant women; 25 HIV counseling and testing (CT) that tested 15,904; and 49 care and treatment service sites that provided ART for 73992 ever on treatment.

Columbia's approach to program implementation, in line with the GOM, is informed by the following key principles and goals: 1) Increase communities' access to quality HIV prevention, care and treatment services, by improving service provision for: CT, laboratory services, PMTCT, adult and pediatric care and treatment, management of HIV-TB co-infection; 2) Improve facility and community linkages and integration of HIV and primary health services to provide a continuum of services, including maternal and child health and reproductive health services. 3) Support sustainable Mozambican systems through emphasis on strengthening government and community capacity to deliver and manage services at provincial and district level, and development of a handover plan of project activities to Mozambican authorities. These activities include: human resource and MOH capacity strengthening; physical infrastructure development; provision of technical assistance in program management and implementation; and commodity logistics management. 4) Support clinical services, logistics, M&E and laboratory technical advisors in each province where Columbia is lead partner. 5) Assist the MOH in the development of robust M&E systems for HIV-programs that can be adapted for use across the health field.

These program goals contribute to the following Partnership Framework (PF) goals: Goal 1: By reducing sexual transmission of HIV and improving access through increased geographic coverage and improved facility-community linkages for HIV services Goal 2: By utilizing innovative approaches to community mobilization and linking facility and community based care to reduce loss to follow up Goal 3: By increasing Provincial and District MOH capacity through technical and managerial support and sub agreements; supporting 'Gap Funding', training and supervision; renovating health facilities; strengthening commodity procurement systems; and improving HIV services integration with other health services Goal 4: By ensuring effective facility and community linkages, referral systems and patient tracking at ART and non-ART service sites; increasing emphasis on integrated child and adolescent services; strengthening of lab support Goal 5: By increasing access to a continuum of HIV care services through nutritional interventions and better community-facility linkages

Columbia priority assistance is to strengthen local health systems in line with GOM and the PF priorities: support MOH's decentralization process by building DPS and SDSMAS capacity; strengthen human resources at the provincial, district and site level; infrastructure rehabilitation; improved logistics management in provinces, districts and sites; and mobilization of community resources to foster linkages with health facilities and create demand for services.

Cross cutting issues addressed in program implementation include: 1) Linking clinical services with community services to improve nutrition through nutritional education, counseling and promotion of locally appropriate, nutritious foods. 2) Development of a gender strategy for each province, including activities designed to improve male access to HIV services e.g couple counseling and consultations; and activities to reduce violence against women. 3) Child Survival Activities: early infant diagnosis, infant feeding counseling, Cotrimoxazol prophylaxis, mothers groups for nutritional education. ???Safe motherhood: CT within Family Planning, family planning in MCH and PMTCT programs; supporting maternities for improved care, safe deliveries, and promoting appropriate breast feeding practices ???Malaria (PMI): collaborate with MoH and Malaria Consortium for the distribution of ITNs 6) End of program evaluation: analysis of routine data and formal evaluation of program performance using standard performance indicators

Cost efficiencies will be improved by utilizing existing resources (staff, services, structures and relationships with communities), adapting promising practices from local, regional, and international initiatives, and strengthening linkages with public health services and maximizing on facility and community based services in target areas. In addition, transition of technical and managerial responsibilities to DPS/DDS through 6 sub agreements as part of the will over time reduce overheads. Columbia will leverage resources through linking with other USG and international donor projects.

Columbia will strengthen monitoring and evaluation activities through support for robust systems for HIV related programs that can be adapted for use across the health field. Activities will include support for roll out and scale up of new M&E tools, training, supervision, and technical assistance with a focus on data quality and utilization. Next generation PEPFAR indicators will be used for program monitoring and Columbia will have detailed plans to report against these indicators.

ICAP currently supports the scale up and provision of quality ART services in Maputo City, and Gaza, Inhambane, Zambezia, and Nampula provinces. As of the end of September 2009 (APR 2009), ICAP is supporting a total of 49 sites in 28 districts; 73,992 patients ever treated of whom 51,622 (70%) were currently on ART (excluded is data from 6 sites that were transitioned to other partner support between January and June 2009 and one site that did not report in APR09 - 24 de Julho Health Center). ICAP's program is aligned with the Mozambique treatment guidelines, the Partnership Framework goals and with the Track 1 transition process.

In FY 2010, support will be expanded to 17 sites; including 5 additional sites in 6 priority districts in Inhambane (5) and Nampula (1) provinces to reach a total of 66 supported sites in 34 districts. The target is to provide ART to 59,078 patients by September 2010. Expansion plans are in accordance with the government's ART services decentralization and integration plans; a process initiated in January 2009 within the major urban treatment facilities including 6 newly Columbia supported sites for FY 2010. ICAP has been providing technical support for this activity to enable large urban sites to down-refer stable patients and ensure that patients are retained in care and treatment. Support will also be provided to enable urban Health Centers to absorb the referred patients and initiate ART for new patients.

Support to the DPS and Ministry of Defense through the 6 existing sub agreements will be increased to include provincial level monitoring and supervision of the HIV program. Scale up of prevention with positive activities, early treatment initiation, cotrimoxazole prophylaxis and TB screening within ART service sites will be prioritized.

Specific activities planned in FY 2010 include: 1) Finance MOH staff positions; 2) Train and mentor MOH staff; 3) Provide equipment and supplies for facility operations; 4) Improve patient management, drug management and strategic information systems; 5) Reinforce patient follow-up and referral systems; 6) Strengthen linkages with CT sites, TB clinics, PMTCT centers and PLHIVservices; 7)Expand prevention with positives programs within ART service sites; 8) Implement and monitor the Track 1.0 transition process; 9) Mainstream infection prevention control; support workplace programs including PEP.