Although the majority of new HIV infections in Mozambique occur in the general population, some population sub-groups are at significantly elevated risk. PSIs project goal is to improve the quality of HIV prevention activities, increase access to HIV services ultimately reduce HIV transmission rates among most-at-risk populations (MARPs) in Mozambique. Objectives will be achieved through promoting a package of interventions and preventive services and the implementation of a set of core public health components of outreach work, HIV testing (CT), risk reduction counseling, condom distribution, and linking MARPs who are PLHIC to HIV care and treatment. Current program activities will include gender based violence aspects, especially focusing on female sex workers and their clients, miners and their wives who are particularly vulnerable groups through training of peer educators on GBV prevention and care, as well as training of HIV counselors for ATSC to diagnose and refer victims of GBV in their communities. Advocate for inclusion of GBV as part of the ATS curriculum with MISAU. Train police leaders in each province about GBV and their role in protecting women. In addition, project will produce IEC material on GBV for target population and dissemination of a radio spot in select provinces. PSI will continue to target the provinces of Cabo-Delgado, Nampula and Inhambane. Target MARPs include persons engaged in sex work and their clients, drug-using populations, men who have sex with men (MSM), and mobile populations. Expenditures from the 2011 expenditure analysis places PSI within an acceptable range of unit expenditures. In line with priorities of the Partnership Framework, this activity will strengthen capacity of local organizations and government.

PSI CDC will continue its support to MOH through an alignment of FY 2012 activities with overall PEPFAR Counseling and Testing goals and strategies, with a focus on strengthened linkages from HTC to other services.

Through mobile and outreach as well as home-based HTC Samaritans Purse will target Most At Risk Populations, (CSW and their clients, IDU, MSM, Miners and their wives) who are less likely to access facility based health services.

Quality assurance is a priority and PSI will continue using on-going supportive supervision including direct observation approach to be sure that each counselor performs HTC service delivery correctly. Additionally, all of PSIs counselors will participate in a training designed by the National health Institute to improve the quality of HIV rapid diagnostic testing.

Whereas in previous years, counselors simply gave referral slips to HIV positive clients, with COP 12 funds, PSIs counselors will have a stronger role supporting newly diagnosed clients by personally introducing them to existing peer educator/peer navigator/case manager volunteers who will navigate or escort clients to enroll or register for follow up services, including positive prevention or the new MOH pre-ART service delivery package and support groups. For those newly diagnosed who do not enroll in HIV care and treatment services, CT counselors will continue using the door to door approach to re-visit already diagnosed HIV positive to monitor their enrollment and adherence to recommended treatment and care through the positive prevention or pre-ART support groups. HIV negative clients will be encouraged to bring their partners in for testing and reduce their risk through condom use and partner reduction. Where available, counselors will refer HIV negative men to medical male circumcision services.

PSI will work closely with the USG and partner Strategic information teams to develop and utilize instruments to document and measure CT service uptake as well as service-to-service and facility-to-community linkages to ensure follow-up, retention and adherence of clients diagnosed with HIV.

Activities will be conducted at central level with GOM, and in three provinces: Cabo Delgado, Nampula, and Inhambane. Activities will include elaborated/adapted curricula for IEC, BCC, risk reduction, etc.; approved and disseminated policy and materials for MARP interventions at national and provincial level; and demonstrated strengthened linkages of MARPs with care and treatment facilities (referral charts, monitoring instruments), establishment of moonlight clinics, etc.

Measurable outcomes of the program will be based on number of individuals trained to implement MARP interventions; number of individuals reached with MARP interventions; and capacity building for sustainable interventions, including demonstrated evolution of organizational capacity of local organizations.

Activities will also include implementation of a surveillance system at designated STI night clinics established for FSW and other MARP groups. This surveillance system will be implemented in order to provide much needed qualitative and quantitative information around specific MARPs groups in a clinical setting. Such data collection is considered a critical SI activity in that data around MARP populations in these settings has been a traditionally difficult data set to collect. As part of the need to move towards more evidence-based intervention programs, more quantitative and qualitative information around specific MARP groups is critical in the scaling-up of MARP evidence based interventions and programs. In addition, it is expected that this surveillance activity will begin to assist both the MOH and the NAC in developing more comprehensive datasets around MARPs. Such surveillance should also provide information about the effectiveness of MARPs oriented activities and interventions supported by the USG.

Population Services International (PSI) will continue to focus on community-based implementation through a cadre receiving training through newly established training institutes for MARPs interventions in close collaboration with a complementary training partner in the identified provinces. Current program activities will include gender based violence aspects, especially focusing on female sex workers and their clients, miners and their wives who are particularly vulnerable groups through training of peer educators on GBV prevention and care, as well as training of HIV counselors for ATSC to diagnose and refer victims of GBV in their communities. Advocate for inclusion of GBV as part of the ATS curriculum with MISAU. Train police leaders in each province about GBV and their role in protecting women. In addition, project will produce IEC material on GBV for target population and dissemination of a radio spot in select provinces.Additionally, this IM receives Central GBVI funds.