The purpose of this program is to progressively build an indigenous, sustainable approach to the national HIV epidemic through the rapid expansion of innovative, culturally appropriate, high-quality HIV prevention, care and tx interventions, and improve linkages and coordination between the national (central) and provincial response to HIV counseling and testing, HIV tx and care services targeting rural and other underserved populations, and addressing (developing and strengthening) the shortage of human resources. The USG, through this CoAg, will continue to support the MOH in the areas of PMTCT, other prevention (STIs), Injection Safety, Adult Care and Support, Adult Treatment, TB/HIV and other opportunistic infections, Pediatric Treatment, Strategic Information, and Health System Strengthening.Activities included in this CoAg will directly contribute to the five goals of the Partnership Framework: Reduce new HIV infections; strengthen the multisectorial HIV response; HSS, HRH and social welfare; improve access to quality HIV tx services; ensure care and support for pregnant women, and others infected or affected by HIV. The scope of this collaboration is national in scale. By funding the MOH directly, the USG strives to achieve cost effectiveness of Mozambican programs as well as build the capacity of the National Government to implement HIV programs.MOH is working on strengthening and further develop their National M&E plan, Modulo Basico, which captures Health data nationwide. The USG Moz indicators are aligned with this plan and currently share 20 indicators.This partner's funding has been reduced given existing pipeline. The pipeline reduction accounts for $2,500,000; thus overall funding to partner is $5,104,243. No vehicles planned with this funding.

In FY 2012, through PEPFAR funds, the USG will provide direct technical assistance (TA) to the Ministry of health (MoH) to ensure the provision of HIV related care and support services to adolescents, adults, women, and MARPs, including children.

At central level the support will be directed to the development of policies, guidelines and strategies to address some of the pressing barriers such as access to pre-ART services, quality and retention in care.

In June 2011, The MoH organized a national retention conference and the main recommendations are:1. Further scale up of ART services to remote areas2. Implement community adherence support groups;3. Improve follow up of pre and ART patients (adherence and CTX prophylaxis)4. Improve quality of service across all care and treatment programs

To ensure that these priorities are accomplished, the USG support will be directed to the following activities:

1. Roll out the Pre-ART package of care and support services to HIV infected patients. This will increase access to diagnosis of opportunistic infections and cotrimoxazole prophylaxis, TB screening and INH prophylaxis, STI diagnosis and syndromic management, nutrition counseling, adherence support and other services that will contribute to link and retain patients in care. Thus, funds will be allocated for reproduction and distribution of guidelines and algorithms, updating and reproduction of training materials, and central level supervision to provinces and districts. In addition, integration of Pre-ART with positive prevention (PP) interventions will be prioritized, addressing the development of the national strategy of PP/Pre-ART, regional TOTs for healthcare workers and reproduction of training materials, job aids, posters and PP tools.2. A new evidence-based initiative of ART groups, known as GAAC (grupos de apoio a adesao comunitaria), will also be implemented, to improve retention rates of HIV positive people enrolled in clinical care nationally. Funds will be used for training, M&E tools, workshops and supervision.3. Universal access to peer educators (PE) support will be scaled up to improve adherence and retention of ART and Pre-ART patients in care. Implementing PE support, on one hand, will strengthen linkages between services at health facility, and on the other hand will build strong referral systems and linkages with existing community care and support programs. This will also allow bidirectional collaboration between clinical and community partners. Therefore, there will be standardization of PE`s role across all partners, harmonization of the national strategy of PE, curricula development, and reproduction of manuals, guidelines, and tools.4. Expand the national cervical cancer prevention and control program to 42 new sites. So funds will be allocated for: national meetings; supervision, reproduction of guidelines and IEC materials.5. Jointly work with the National Institute of Traditional Medicine to ensure training of traditional healers to increase awareness about HIV/AIDS and other diseases, improve the linkages/referral systems between traditional practitioners and the health facilities.6. Support the implementation of the new home based care (HBC) strategy with emphasis on adherence support, palliative care and nutrition support. Redefine the profile of the care provider to merge HBC and home visits at community level.

In 2012 MISAU will continue to implement the TB/HIV collaborative activities by 1) Strengthening the implementation of the 3 Is- intensified TB case finding (ICF), Isoniazid preventive therapy prophylaxis (IPT) and infection control (IC); 2) provision of cotrimoxazole preventive therapy (CPT); 3) universal anti-retroviral treatment (ART) for all HIV-infected person who develops TB disease (irrespective of CD4); 4) integration of TB and HIV services including scaling up the implementation of one stop model 5) strengthening of the referral system and linkages with other services (ATS, PMTCT) to ensure that TB suspects are diagnosed with TB and successfully complete TB treatment under DOTS, 6) IC assessment and developing to reduce nosocomial TB transmission in health facilities; 7) ensuring that all key clinical receive training on TB/HIV, and MDR-TB including management of pediatric TB including management of contacts for both sensitive and resistant TB.Additionally funds will be used to continue training of clinicians on the management of TB, TB/HIV and X/MDR-TB in adults and children. Finally, the referral system and linkages with other services (ATS, PMTCT, ART) will be strengthen, supportive supervision will be conducted and implementation of the new recording and reporting including the MDR-TB data base will be implemented.

This continuing activity reflects a general strategy designed to build and strengthen MOH capacity in strategic information, with a particular focus in monitoring and evaluation (M&E), information systems, and human capacity development. These funds will support activities in these areas for which the National Directorate for Planning and Cooperation are responsible (which include M&E and Health Information Systems.) In COP 12, $250,000 has been budgeted in this area.Planned activities will be implemented through the Ministry of Health to implement the National Strategic Plan for Health Information Systems (2009-14). Areas of emphasis include:Information systems and standards developmentStrengthen mortality surveillance systemsUpdate & maintain a national registry of health facilities.Implementation of the Health Information System for the Hospitals with aggregated data using CID-10 reduced list of morbidity and mortality.Strengthening Human Resources in Information Systems (including curriculum development in both pre- and in-service settings.)Funds may also be used to support implementation of the National Plan for Monitoring and Evaluation (2012-2014), which was developed with significant technical support from USG; this national Plan should be finalized and approved by end of 2011. Activities supported will be linked with MOH priorities and may include:Strengthening human resources through training, professional development, mentoring and supervisionStrengthening coordination of monitoring and evaluation systemsReinforcing systems to ensure high quality and use of data

In FY12, PEPFAR funds will continue to support the following OHSS activities.1) Printing of materials: manuals and pamphlets 2) Finalization of the General Nursing and MCH curricula.3) Scholarships for health workers to upgrade skills to get superior level degree at ISCISA4) Purchase of materials (Computers )5) Purchase of office supplies for the Training Department6) Supervision visits to training institutions7) Health workers prevention programThis partner has a significant pipeline ($556,000) therefore those funds will be used to perform FY12 activities. The amount allocated in FY12 ($68,000) will be used to perform activities on the health workers prevention program.

The goal of the injection safety program is to reduce the risk of transmission of HIV and other blood borne pathogens among health care personnel at health facilities in Mozambique. The National Directorate of Medical Assistance (DNAM) of the MOH closely linked to the National Nursing Department has been implementing a nationwide Infection Prevention and Control (IPC) program that coordinate, implement and supervise the prevention of medical transmission activities in the country.USG resources have been utilized to implement the IPC program and will continue to support the MOH staff to roll out training to health workers of health units where there is no partner. This enhances the MOH staffs capacity to utilize training materials developed with assistance from USG supported partners, and to implement activities on their own, strengthening their confidence and implementation experience in the absence of outside support, which in turn will contribute to long-term sustainability and continuation of the program activities.In FY 2012 the goal is to continue to strengthen the role of the MOH IPC program, in particular the nursing department and DNAM in the expansion and institutionalization of the IPC efforts including adequate sharps and other infectious waste disposal, PEP and work place safety scale-up throughout the country. Key activities include:Enforce implementation of Infection prevention and control(IPC) procedures in all facilities including development/update of policies, guidelines, monitoring and evaluation and data management system for IPCstrengthen and increase availability of comprehensive Post-Exposure-Prophylaxis services and improve the data management system for PEP occupational and non-occupationalImprove infectious waste management system using appropriate approaches, including finalization and dissemination of policies and guidelines, standard operational procedures and monitoring toolsensure provision of commodities and supplies such us: gloves; boots; aprons; eye wear for compliance with IPC standards.

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 PITC. MOH will also be involved in the training, technical assistance and supervision of clinical staff to develop and implement a strategy to improve coverage and quality of PITC for inpatient and outpatient services.

Quality assurance is a priority and MOH will continue using on-going supportive supervision including direct observation approach to be sure that each clinical staff performs PICT service delivery correctly.

Whereas in previous years, counselors and clinical staff simply gave referral slips to HIV positive clients, with COP 12 funds, MOH will ensure that health care service providers 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.

Part of the objectives of the HIV/AIDS Prevention, Care, Treatment, and Support in the Republic of Mozambique under the Ministry of Heath are to improve the quality of health care services for most at risk populations (MARPs) by developing and disseminating health care guidelines on MARPS assistance. Activities for FY12 will focus on the design and dissemination of specific guidelines for the provision of quality of services, care and treatment for HIV/STI among Marps and through capacity building to health workers to ensure knowledge and quality of services to MARPS. The Ministry of health, through the national directory of medical assistance (DNAM) will lead the development of these guidelines,

This activity is national, with extensive central-level coordination as well as implementation activities at provincial level. Health professionals are the target population. Activity focus on specific needs of female sex workers and their clients, minors and their wives, drug users and men who have sex with men, includes an embedded cross-cutting gender component including gender equity interventions as well as information and screening for GBV.

Expenditure analysis methodology has not been established for this activity.

This activity will increase capacity of the health sector particularly to deal with specific health care needs of most at risk populations, including STI, HIV/AIDS. The program also extends technical capacity building to service providers at community level as well as raise awareness on HIV and AIDS among this population groups and its impact in communities. It will also ensure coordination within health care institutions, referral services, in close coordination with clinical partners at community level and with the National Aids Council (CNCS).

M&E for this technical assistance project will be through successful completion of key deliverables.

Pipeline has not been considering in FY12 budget requests.

No vehicles are requested.

During FY2011 the MoH was envolved in policy development and/or implementation that is re-shaping PMTCT program in the country: a) Since July 2011 the country started rolling out revised WHO guidelines that recommend provision of more effective prophylactic regimens for PMTCT and safer infant feeding options Option A; b) Task shifting policy that authorizes MCH nurses to prescribe ART for HIV+ pregnant women, which will improve access to ART for eligible women and in need of treatment for their own health; c) Endorsement of the Global Plan for Elimination of mother-to-child transmission (E-MTCT) of HIV up to 2015, resulting in revision of countrys PMTCT targets and development of an acceleration plan towards E-MTCT. Key priorities for the GoM are focused in synergetic interventions in all four prongs of PMTCT namely: 1) Prevention of HIV in women; 2) Prevention of unintended pregnancies among HIV+ women; 3) Prevention of mother-to-child transmission of HIV; 4) Care and support for HIV+ women, infants and families; other interventions include community based approaches to increase demand creation for service utilization including male involvement, linkages between health facilities and communities to optimize retention and adherence to the program; strengthen laboratory capacity to improve access to CD4 and PCR testing; strengthen the supply chain management for drugs and commodities for PMTCT; improve human resources capacity to deliver quality and effective PMTCT and, strengthen the M&E system at all levels.In FY2012, following are the Key activities the central level MoH will implement with direct USG technical and financial support:1) General oversight of implementation of E-MTCT acceleration plan;2) Develop operation strategies for the task shifting for MCH nurses provision of ART in MCH services;3) Reproduction of revised training materials;4) PMTCT supportive supervision, including team visits from central level to PMTCT sites, support for provincial supervisory teams. Central-to-provincial support for PMTCT will be coordinated through the MOH reproductive health department;5) Community PMTCT activities will also be supported, including finalization of support group materials and policy at national level, with subsequent dissemination and rollout.USG funding for these activities will complement funding for PMTCT acceleration plan support provided through USG implementing partners and by other agencies such as WHO, UNICEF, and the Global Fund.

The National Directorate of Medical Assistance (DNAM) in the MOH continues to be responsible for monitoring implementation of the HIV treatment program.Priority areas are increased treatment access; ART retention; ART Quality assurance; program linkages and integration especially with CT, TB, PMTCT, nutrition, and pre-ART services.

The MoH continues to seek programmatic efficiencies through conducting integrated supervisory visits with multi-disciplinary teams.The MoH has approved the pilot of Community Adherence Support groups (GAAC) in all the provinces of the country. Monitoring and reporting tools which MoH has approved have been developed with support from partners.New ART registers and forms that enable longitudinal tracking of patients both on ART and Pre-ART have been developed and planned for dissemination throughout the country. These forms will provide information on retention, loss to follow up in both ART and pre-ART patients even without an electronic data system..Currently this information is primarily only available from implementing partner supported electronic patient tracking systems.

Funding will support the MoH to undertake the following are systems strengthening and capacity building activities:1) ART training of health care providers2) Provincial supervision and lead process to task shift ART to nurses, and middle-level health providers3) Participation in key HIV related meetings and conferences for MoH staff4) English courses for MoH staff to improve ability to manage cooperative agreement requirements5) Convene a national HIV meeting of provincial teams to review program data and identify strategies to improve where there are areas of weakness.6) Strenghthen M&E section to better map HIV service provided in the country

The M&E department routinely tracks clinical outcomes that are reported monthly by provinces. These data are analyzed and posted on the MoH website.

The National Directorate of Medical Assistance (DNAM) in the MOH continues to be responsible for monitoring implementation of the HIV treatment program.Scale-up of pediatric HIV is a national priority including ensuring implementation of new guidelines nationwide. The MoH has revised upwards and approved new pediatric targets based on ART initiation for all children <24 months.Activities to expand pediatric enrollments and access to diagnostic services include improving patient flow and specimen referrals to increase access to EID, CD4 testing; implementation of continuous quality improvement programs; early initiation of treatment.The systems strengthening and capacity building activities that will be supported in Fy12 to enhance capacity of sites and health care providers include: Training on pediatric HIV care and treatment, supportive supervisions and mentoring; provision of job aids, implementation of new national Pediatric Treatment Guidelines; Routine supervision, monitoring and collection of data on pediatric treatment will be ensured through implementation of QI activities, Patient tracking systems and strengthening of district and provincial ART management committees.

Adherence and retention strategies are addressed through the MoH psychosocial TWG there are considerations being discussed to include pediatrics in the pilot of Community Adherence Support groups (GAAC).Strategies to ensure increased integration and linkages of HIV services with the existing child health and other programs to reduce loss to follow and improve retention include: prioritization of children in ART clinics, assuring same day consultations for mother and child in PMTCT services, developing formal referral systems between ART clinics with TB, PMTCT, Counseling services, CCR and EPI programs and with the community; ART initiation within CCR clinics.

The M&E department routinely tracks clinical outcomes that are reported monthly by provinces. These data are analyzed and posted on the MoH website.