Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4859
Country/Region: Mozambique
Year: 2007
Main Partner: Columbia University
Main Partner Program: NA
Organizational Type: University
Funding Agency: HHS/CDC
Total Funding: $3,283,125

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $2,603,125

This activity is also linked to 8588, 8638 and 8545 activity sheets. Since the beginning of scale-up of PMTCT and treatment services in Mozambique, Columbia University (CU) has collaborated with the Ministry of Health (MoH) to support PMTCT and treatment service expansion nationally. HIV-infected pregnant women participating in PMTCT programs are referred to the Day Hospitals where ARV treatment services are supported by CU. The majority of women are currently enrolled in PMTCT during pregnancy. Their infants, other HIV-infected children, HIV-infected partners and family/household members are also offered enrollment. The program provides comprehensive clinical and psychosocial services to the participants with a focus on adherence and retention in care through a multidisciplinary team of providers. In FY07, CU is proposing to continue support for two family-focused PMTCT Model Centers, one at the Jose Macamo Health Center, co-located at the Jose Macamo Hospital compound in Maputo city, and the other at the 25 of September Health Center in Nampula city. Besides PMTCT services provided at ante-postnatal care services, services are also being implemented in two maternities to ensure prevention coverage at model center referral maternities. With funding provided in FY06, the program is currently expanding services to an additional nine PMTCT service sites located nearby, and referring clients to the two Model Centers for delivery and/or specialized consultations. CU plans to support implementation of PMTCT services at an additional six PMTCT service sites next year, thereby completing the PMTCT Model Center referral network and covering all peripheral PMTCT sites within the vicinity of the two model centers. CU will establish PMTCT services at all peripheral ANC clinics referring women for delivery at the model centers. Costs include rehabilitation, supervision and clinical support to peripheral sites. Commodities such as safe delivery kits, essential obstetric drugs and neonatal equipment will be provided. Maternity health care workers will be trained in best obstetric practices to minimize risk of transmission. The emphasis of activities supported during FY07 will be on integration of mother and child care and treatment at the two model centers, increasing the number of infants identified as HIV exposed and/or infected through introduction of early infant HIV diagnosis (1160 expected children), and improving quality of follow-up for HIV exposed infants through 'at risk consultations' and enhancing referral to care and treatment. Support will also include provision of technical assistance to the PMTCT program within the MoH at central level as well as at provincial level in two provinces, Nampula and Inhambane; provision of clinical mentoring and in-service trainings for 72 nursing staff at the model centers; trainings of Mother and Child Health (MCH) nurses in PMTCT, salary support for 15 PMTCT personnel; procurement of supplies and medication required for PMTCT services and not or not regularly supplied through the MoH national supply system, and support for PMTCT-related strategic information activities. During FY07, CU is also planning to initiate support for therapeutic nutritional services for malnourished pregnant women to be provided at both PMTCT Model Centers. In collaboration with the World Food Program, CU will provide nutritional support after the weaning period for children exposed to HIV. This support will include storage costs, distribution logistics management, nutritional training for PMTCT and MCH staff, food procurement, and micronutrient supplementation. Beyond the training activities for Model Center PMTCT staff, CU will continue provincial PMTCT training support, and expand to regional, by increasing the number of MCH staff trained in PMTCT, counseling and testing, pediatric HIV diagnosis ,and infant follow-up (160 trainees). In addition, CU, in collaboration with the MoH and I-TECH, will establish a formal mentorship program with practica for nurses to rotate through the model centers to build their clinical capacity. Community-based Traditional Birth Attendants will be trained to increase their involvement in the community outreach program. Technical assistance will be provided to assist the MOH PMTCT and IMCI staff to integrate pediatric HIV/AIDS diagnosis and care into the existing IMCI curriculum and training program. In addition, Columbia University is proposing to expand and introduce PMTCT services at 14 Columbia University-supported ART sites with existing ante/postnatal care services that are not part of the PMTCT model center referral network, and the establishment and implementation of PMTCT services at an additional maternity in Maputo city. Funds will be used for rehabilitation of space to improve privacy for provision of PMTCT services, training of MCH staff at these sites in PMTCT and infant follow-up, and technical support to establish linkages and referral between services. Selected participants and volunteers in PMTCT are trained to act as peer educators and medication supervisors, creating strong links between the program and community. In FY06, Columbia University's partner CARE worked in Nampula with trained "activists" to support HIV care and

treatment, and enhance community involvement in PMTCT. Columbia University will expand its activities to improve adherence to PMTCT and follow-up of children exposed to HIV at all Columbia University-supported PMTCT sites. This includes technical support for 13 existing and 19 new mother/baby support groups at MCH services, and financing outreach counselors (peer educators or activists) to perform active defaulter tracking.

Funding for Care: Adult Care and Support (HBHC): $680,000

This activity is linked to 8545 and OI logistics systems strengthening described in USAID activity 9117 elsewhere in this document.

The main components of this activity is to provide all HIV patients with a minimum package of quality clinical care services at Columbia University's (CU) 25 ART sites. Patients will receive access to this minimum package of care regardless of whether they have initiated ART. Key components of the care package will include:

1) Management of Opportunistic Infections (OIs) and other acute illnesses, including the prevention, diagnosis and treatment of common OIs as well as screening for HPV/cervical cancer, the provision of cotrimoxazole prophylaxis, pain control, facilitating the distribution of bednets to prevent malaria, and site level support to improve recording and reporting of OIs and a) HIV clinical stage and prophylactic medicines prescribed, b) OIs diagnosed (TB, Cryptococcal Meningitis, Kaposi's Sarcoma (KS)), c) adherence records to medication and clinic reviews d) specific psycho-social issues requiring follow-up and e) eligibility for ART.

Specifically related to the detection and treatment of Kaposi's sarcoma, CU will request funds to hire a Technical Advisor, train health staff in chemotherapeutic agents preparation/KS treatment, renovate and equip treatment areas, and ensure that the M&E system monitors prevalence of KS

2) Provision of psychosocial and adherence support through working with community-based groups and associations, recruitment and training of clinic staff to provide ongoing counseling support

3) Assurances that the continuity of care services beyond the clinical setting are accessible via referrals to community-based organizations that serve the respective health facilities, including referral to counseling and testing as necessary

4) Continued patient and family education about HIV disease, OIs, appropriate nutrition, and HIV Prevention

5) Continued monitoring and regular follow-up to determine readiness and eligibility for initiation of ARV therapy.

To ensure access and quality of service for these five elements, CU will develop a system for tracking the types of services offered and delivered. Additionally, clinic nurses, clinical officers/medical technicians and pharmacy staff will be trained in the provision of standard HIV care services and STI syndromic management. Training will include adult and pediatric HIV management and will be provided in coordination with the Ministry of Health. Finally, CU will work with the MoH and the Provincial Health Office to maintain a buffer stock of OI drugs in case of stock out and to strengthen the logistics system for OI medicines.

Through these activities in FY07: 38,000 PLWHAs will be provided with clinic-based HIV-related care services at 25 Columbia University supported sites including treatment of 10,000 HIV infected adults diagnosed with OI and prophylaxis and/or treatment of 3,000 HIV infected infants and children and training of 380 clinical and pharmacy staff in OI management.

Funding for Laboratory Infrastructure (HLAB): $0

07/07; This activity is being included to be funded under Track 1 funding mechanism for Columbia University, mechanism #4765, because this activity adds to their activity number 8837. The laboratory activities that will be undertaken with this funding are closely related to and support the ARV treatment services that Columbia University is implementing at service sites. This shift will better ensure that the expansion of laboratory services is occurring in harmony with the expansion of ARV services.

This activity is linked to 8545, 8532 and 8540 for treatment services, reagents and equipment supplies and laboratory technician training and quality assurance.

Columbia University (CU) has been implementing ART services in five provinces, both in the major provincial hospitals as well as small district hospitals and health centers. In addition CU contributes to infrastructure development through renovation of health facilities for provision of ART. During FY07 CU will expand services to 9-12 new treatment sites and will renovate and provide necessary supplies and furniture for 9 laboratories that are attached to health centers to ensure that appropriate laboratory services are available for the follow-up of patients on ART in these areas. A good electricity supply, water source and drainage, lab benches, computers and furniture are all considered within the spectrum of support that CU will provide. Part of this funding will also support the salaries of staff responsible for the oversight of CU laboratory projects

APHL will equip and supply hematology, biochemistry and CD4 equipment as needed to these laboratories depending on facility type as well as manage the supply of reagents and equipment maintenance. The Ministry of Health, in collaboration with other Emergency Plan partners, will recruit and provide training of laboratory personnel needed to manage these laboratories.

Subpartners Total: $644,909
Step Namicopo: $140,000
Ceta 25 de Setembro: $488,700
Step 1o de Maio: $16,209