PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008
Continuing Activity - Replacement Narrative:
The University of Washington International Training and Education Center on HIV (I-TECH) has been
committed to providing technical assistance to the Ministry of Health in support of their ambitious HIV
program expansion plans, particularly in the areas of pre- and in-service training curricula and design;
training of teachers, facilitators and mentors for course rollout; and outcome and impact evaluations.
In FY07, I-TECH partnered with Columbia University International Center for AIDS Care and Treatment
Program (ICAP) in developing a PMTCT nurse-mentors curriculum and training, and designing rotational
mentoring programs for model centers in Maputo and Nampula. With FY07 budget allocations, I-TECH will
complete a review of linkages between community- and facility-based PMTCT activities, including
mobilization of community health agents (traditional birth attendants, peer educators, PLWH, etc.), with an
additional focus on PMTCT mother support groups. Community-facility linkages and mother support group
activities include review of national and regional materials, development of revised materials (standardized
guides and other tools), technical support for preparing a pilot of revised materials in selected sites, and
draft a framework for expansion of activities.
I-TECH's objectives in 2008 are as follows: (1) Strengthen PMTCT clinical mentoring programs, adapt the
model to clinic-based mentoring at district level, and expand technical support for clinical mentoring
activities to additional USG partners; (2) Strengthen community-based PMTCT initiatives through the
provision of technical assistance to MOH and implementing partners, including the establishment of best
practices, the development of a standardized package of tools and job aids, and the refining of a strategy
for comprehensive roll-out to new sites country-wide; (3) Strengthen mother support group activities in
PMTCT settings, in coordination with USG partners to be determined. Specifically, findings from FY07
activities in reviewing and developing models for support will be leveraged to implement and expand
appropriate models; (4) Provide technical assistance to MOH and NGO partners to ensure adequate and
appropriate integration of PMTCT information into pre-service curricula; (5) Provide technical assistance to
MOH and NGO partners for revision of the in-service training manual used for training PMTCT service
providers, which was developed in 2004 and disseminated in 2005; and (6) Develop prioritized job aids in
coordination with USG and partners.
1. Strengthen PMTCT clinical mentoring programs
The continuation of this activity in 2008 would support MOH in the roll out of the PMTCT clinical mentoring
package in selected sites, as well as providing technical assistance for adaptation of the mentoring package
to accommodate site-based mentoring and supervision at the district level.
Activity 1.1: Provide on-going technical assistance to ICAP, as appropriate, to strengthen the design and
impact of the mentoring program in the model centers, including the development of a plan for the clinical
staff of other partner organizations to participate in mentoring rotations. I-TECH will also collaborate with
other implementing partners to adapt the mentoring model to local contexts. 20 nurse-mentors will be
trained, in addition to 6 trainers from the Elizabeth Glaser Pediatric AIDS Foundation. I-TECH will provide
technical assistance in the adaptation of the mentor curriculum, assist in the training of the mentors, and
assist in the adaptation of evaluation tools.
Activity 1.2: I-TECH will work with implementing organizations to conduct training for 30 district-level
PMTCT supervisors with the aim of fortifying their PMTCT supervisory skills, including the incorporation of
mentoring techniques into their visits. This activity would provide additional on-site support for the nurses
who rotated through the model centers, as well as those who received on-site mentoring.
Activity 1.3: As the mentoring programs evolve, it is likely that the need for new or improved job aids will
become apparent for both the mentors and the newly trained PMTCT providers. I-TECH will develop
prioritized job aids in support of the new information and skills, as recommended by MOH and partner
2. Strengthen community-based PMTCT training and mother support activities
Community-based positive mothers / mother-to-mother support groups are recognized as important
instruments for increasing use and adherence to PMTCT services, encouraging early treatment access for
mother/infant pairs, improving linkages between community and clinic based services, tracking defaulters,
and supporting positive mothers and mothers-to-be, both psychosocially and for purposes of medical
adherence including ARV regimens, longitudinal follow-up, facility delivery, and post-partum care for mother
and child. The groups also assist women to resolve issues around infant feeding and provide needed
emotional support for combating stigma in their homes and communities.
The activities under this objective build on I-TECH's ongoing work to review materials, develop a
framework, and pilot materials for improving linkages between facility-based and community-based PMTCT
activities, as well as improving mother support groups that have been poorly organized and insufficiently
equipped to guide activities.
Activity 2.1: I-TECH will provide technical assistance to MOH and implementing partners to establish best
practices and refine the implementing framework developed in 2007 in order to ensure standardized rollout
of high quality support packages. In collaboration with MOH, I-TECH will coordinate and sponsor a
workshop analyzing best practices and lessons learned in the provision of support to HIV positive mothers
and pregnant women. I-TECH will work with the partners and MOH to further develop the framework
developed with FY07 funding, develop guidelines for establishing community based support services, and
develop a model and strategy for rolling out quality positive mother / mother-to-mother support programs to
new sites. Of critical importance is the goal of developing a strong linkage between clinic-based services
and community-based support in order to improve use and access to both PMTCT and treatment services
for mother/infant pairs.
Activity 2.2: As the best practices, support package contents, and the framework evolve, I-TECH will
develop standardized job aids and tools for piloting by the implementing partners with community support
Activity 2.3: During the roll-out, I-TECH will provide technical assistance to MOH and partners to ensure that
the model is achieving results. Activities may include a small targeted evaluation, and include
recommendations for further adaptation of materials and trainings methodologies.
3. Strengthen PMTCT integration into pre-service curricula
Since 2006, I-TECH has been committed to supporting MOH in their efforts to develop high quality and
standardized pre and in-service training curricula. I-TECH's focus to date has been on the provision of
training of pre-service teaching faculty, and the development of pre and in-service curricula for Tecnicos de
Medicina (TdM) and Maternal and Child Health (MCH) nurses. I-TECH placed a specialist within the MOH
Training Department in 2007 to provide training to MOH staff in curricula review.
I-TECH will work closely with MOH to jointly review and analyze existing and new pre-service curricula for
different health cadres (nurses, physicians, TdM) and make recommendations for strengthening the PMTCT
components, as appropriate.
4. Provide technical assistance to MOH and NGO partners for revision of the in-service training manual
used for training PMTCT service providers
The PMTCT in-service training manual was disseminated by MOH in 2005, based on design and
development in 2004. Since that time, significant revisions in international and national PMTCT policy and
practice have been made, and updates to the training manual have been provided in periodic memos from
MOH. Currently the training manual contains outdated and partial information for PMTCT services, and
there is no single resource document or training manual available to meet the needs to PMTCT service
providers in Mozambique. This activity will build from FY07 efforts by USG partners to develop a CT section
for the PMTCT manual.
I-TECH will provide support to MOH and additional NGO partners in the finalization of the PMTCT in-service
5. I-TECH will integrate PMTCT curricula review activities into its ongoing capacity building program for
The combination of described activities will ensure that the relevant issues are addressed at multiple levels,
from the technical training and support for the clinicians providing medical services for pregnant women and
mother/infant pairs, to the strengthening of community groups and agents encouraging adherence to
medical advice and treatment.
The activities are designed to strengthen the linkages between local health services and community-support
interventions, ensuring the flow of correct information to women and providing them with a supportive
environment to combat stigma, make healthy choices, and improve the use of PMTCT services from ANC to
follow up of both mother and infant.
One of the key objectives of the Ministry of Health (MOH) Strategic Plan to Combat STIs, HIV, and AIDS for
2004-2008 is to reduce the impact of HIV/AIDS on health care workers. As a primary means of prevention,
behaviors associated with HIV transmission must be addressed, especially those sexual behaviors that put
individuals at greatest risk of infection. To date, there are few existing activities that support health workers
in dealing with HIV/AIDS risk behaviors and that address issues of abstinence, delay of sexual debut, and
faithfulness to one's partners. The focus of this activity is to promote these behaviors and strengthening the
norms that support them. FY 08 funds are being requested to support the University of Washington through
its partner Global Health Communications (GHC), a partner with experience in the successful development
and evaluation of Behavior Change Communication (BCC) interventions in the African context. Activities
that this partner will support in Mozambique include:
(a) Building on the results of quantitative and qualitative assessments conducted with funding support from
FY06/07, to identify informational and educational gaps that might be quickly and efficiently addressed by
adapting existing A/B materials. Most of these may be print-based, but there may be radio PSAs that can be
identified. Some of these materials may be circulating in parts of Mozambique, but the partner will be
encouraged to identify materials from other countries in the region that may be translated into Portuguese
and other local idioms as well as material from other lusophone countries (e.g., Angola, Brazil, Cabo Verde,
Guinea Bissau) that may be modified to address the Mozambican context;
(b) Creating new A/B informational/educational materials where existing regional or lusophone materials do
(c) Developing and piloting behavioral and educational interventions focused on issues of abstinence and
(d) Evaluating pilot interventions to assess their personal life effectiveness, and;
(e) Training and on-the-job mentoring of MOH staff from human resources, training, health education
departments, and HIV/AIDS/STI program in evaluation of A/B behavior change and educational
This activity sheet describes support for two components:
The first component is proposed for funding ($100,000) for the following activities: Health workers in every
country play an important role. In developing countries such as Mozambique, this role takes on an even
greater magnitude as this segment of the population is critical to the entire nation's fight against HIV/AIDS.
For this reason the Mozambican MoH has declared that reducing the impact of HIV/AIDS among health
workers (including support and administrative staff in addition to students currently enrolled in health
institutes) is one of their highest priorities. In addition to A/B-related information, post-exposure prophylaxis
(PEP) and condom use behaviors are very central to prevention within this population. Condom use is an
important tool in prevention in a situation such as Mozambique where health workers are frequently rotated
to positions away from their homes. FY 08 funds are being requested to support the University of
Washington and its partner Global Health Communications (GHC) with experience in the successful
development and evaluation of Behavior Change Communication (BCC) interventions in the African context.
Activities that this partner will support in Mozambique include:
(a) Using the findings of quantitative and qualitative studies to identify informational and educational gaps
that might be quickly and efficiently addressed by identifying existing PEP and condom-use promotional and
educational materials. Many of these may be print-based, but there may be radio PSAs that can be
identified and adapted to the Mozambican context. The partner will be encouraged to identify materials
from other countries in the region that may be translated into Portuguese and other local idioms as well as
materials from other lusophone countries (e.g., Angola, Brazil, Cabo Verde, Guinea Bissau) that may be
modified to address the Mozambican context;
(b) Creating new PEP, condom marketing, and other prevention materials where existing regional or
lusophone materials do not exist;
(c) Designing and facilitating a local stakeholder meeting at which study findings related to issues of
condom use, PEP and other prevention measures will be disseminated. Attendees will be members of the
MoH working group, and NGO/CBO communities working in the area of HIV prevention. Participants will
develop recommendations based on the findings, and identify opportunities for collaboration among
(d) Developing and piloting C&OP behavioral and educational interventions (including training local
implementing partners), and;
(f) Assisting the MoH in the evaluation of C&OP pilot interventions to assess their effectiveness both in the
workplace as well as in workers' personal lives.
The second component is proposed for funding ($150,000) is: Mozambique's International Rapid
Assessment Response and Evaluation (I-RARE) has been designed to better understand, assess, and
make recommendations for how to respond to rapidly changing sexual risk and drug using patterns that
increase vulnerability to HIV infection among sex workers and drug users in three cities in Mozambique,
Maputo, Beira, and Nacala Porto, Mozambique. The assessment explores the presence of drug and alcohol
use and high risk sexual behavior in sex workers and injection (IDU) and non-injection drug users (NIDU),
including drug use among sex workers, and sexual risk behavior among drug users. The potential for
overlapping risk behaviors, sexual mixing among these populations, and bridging to the general population
exists, and may be contributing to the rapid spread of HIV in the country. The possibility of increased HIV
risk creates the need for targeted prevention programming and improved access to services for these
populations. I-RARE supported through funding from FY06/07 will provide recommendations for introducing
and scaling up sustainable interventions designed to reach sex workers and drug users. Findings will be
analyzed and used in FY08 to develop recommendations for targeted approaches and feasible public health
interventions in these populations. FY08 funds are being requested to support the development,
implementation, and evaluation of prevention activities relating to at risk populations. Activities will include:
(a) Developing and piloting outreach activities for sex workers and drug users, and enhancing the capacity
of NGOs to introduce and or strengthen outreach to sex workers (this may entail adapting processes and
procedures developed in South Africa following the rapid assessment and designed for their FY07 COP
(d) Facilitating a workshop to adapt an outreach manual focusing on condom promotion and HIV prevention
among sex workers and drug users, with the NGOs/CBOs to ensure that outreach activities are based on
data from the rapid assessment and best practices. The training workshop will include components of the
community-based outreach such as risk reduction counseling. The NGOs will then in turn train potential
outreach workers both from their organizations and other members of local consortia to access hidden
populations and provide risk reduction strategies related to injecting and non-injecting drug use and sexual
(e) Developing venue-based interventions that deliver HIV prevention information, in particular information,
education, and/or skills based training on sexual risk reduction, especially as related to HIV risk in the
context of drinking alcohol. Distribute condoms in formal and informal drinking venues; refer patrons to
alcohol treatment and/or social services as appropriate. Refer patrons to HIV/AIDS care and treatment, and
provide information on prevention for positives and, specifically, information on the relationship between
alcohol and adherence to ARVs;
(f) Identifying monitoring and evaluation forms previously used in countries such as Vietnam, Thailand and
Kenya will be adapted for use in Mozambique.; and
(g) Facilitating on-going technical assistance in collaboration with to CDC to provide training on how to
monitor and evaluate outreach activities.
According to a WHO working paper (Key Elements in HIV/AIDS Care and Support,2002) major barriers to
implementing the key components of palliative care and treatment often stem from systemic, organizational
or policy shortcomings. These include: Low priority of HIV care within national health budgets; lack of
investments in building infrastructure; insufficient remuneration and support for care professionals; loss of
staff due to high HIV-related mortality and morbidity; shortages of relevant HIV information and HIV training
opportunities; irregular and inadequate supplies of drugs, reagents, and equipment; and lack of essential
drug lists and drug procurement not adapted to needs of people with HIV/AIDS.
USG policy suggests that addressing the needs of the infected-including treatment of sexually transmitted
infections and opportunistic infections-should be a fully integrated component in any care system that
emphasizes patients' quality of life by ensuring symptom control and supportive therapies combined, when
possible, with disease-specific therapies. (Foley, Aulino, & Stjernsward, 2003).
Yet there are many barriers to providing sex workers and drug users with needed diagnosis and treatment
of STIs and other opportunistic infections. These barriers range from serious financial limitations of both the
government and of families to stigma and social barriers associated with HIV/AIDS and the behaviors of
these populations. Since treating STIs and opportunistic infections are a crucial component of every
comprehensive AIDS strategy, results from a qualitative assessment (I-RARE) supported by USG FY06/07
funds, will be used to determine how at-risk or infected sex workers and drug users access to services
providing HIV and STI screening and treatment can be improved.
FY08 funds are being requested to support the University of Washington and its partner Global Health
Communications (GHC) to work with local civil and governmental stakeholders to consider Mozambique's
capacity to provide STI and HIV screening, early diagnosis and treatment to sex workers and drug users.
Activities proposed for support in Mozambique include:
(a) Directing the analysis of I-RARE data to address STI and OI needs among sex workers and drug users;
(b) Supplementing I-RARE findings with other government and NGO/CBO information about referral to, and
access and uptake of, screening and treatment services within Mozambique's sex worker and drug using
(c) Coordinating a review of successful practices in other countries in the region that have dealt with the
particular challenges specific to
hard-to-reach populations such as sex workers and drug users in creating and sustaining access to STI and
OI testing and treatment; and
(d) Organizing and facilitating a workshop in which Ministry of Health (MOH), other Mozambican
stakeholders and technical assistance from USG and elsewhere develop recommendations, guidance, and
activities that promote the referral, screening and treatment of STIs and OI among sex workers and drug
JHPIEGO: Sub grant to GHC: ; Support for design and piloting of interventions to increase and improve
HIV and STI screening and services for vulnerable populations ($75,000)
The first component is proposed for funding ($50,000) for the following activities: Support development of
materials and interventions targeting health workers to increase Counseling and Testing (CT) uptake and
partners counseling among health workers. One of the key objectives of the Ministry of Health (MoH)
Strategic Plan to Combat STIs, HIV, and AIDS is to reduce the impact of HIV/AIDS on health care workers.
One area that the MoH has singled out for special attention is that of counseling and testing (CT).
Considered a "gateway" behavior, CT and determination of serostatus is prerequisite to many other
behavioral efforts. Mozambique currently offers free counseling and testing services available at 334
locales throughout the country. Although it is presently unknown how many health workers themselves have
undergone testing and counseling, analysis of data gathered as part of a quantitative survey in 2007 will
provide a much clearer picture. According to anecdotal information, the confidentiality of information and
fears of discrimination within one's work environment are concerns of health care workers when considering
whether to access counseling and testing services. These concerns represent barriers to accessing
services, seeking accurate information and examining the risk associated with their personal and
professional behaviors. It is unlikely that HIV risk among health workers can be overcome without
significant changes to attitudes and behaviors. FY06 USG funding has been supporting the development of
an assessment of health workers' current behaviors, attitudes, norms, and knowledge around primary
prevention of HIV and uptake of counseling and testing services, to determine how to better design
interventions promoting structured opportunities for educating and assisting health workers to better deal
with HIV/AIDS in their work and home environment. While the assessments are proceeding, the MoH
human resources, training, health education departments and HIV/AIDS program staff have expressed their
desire and requested assistance for urgent start-up of interventions that will target and support health
workers, facilitating behavior change and improved primary prevention, as well as increased CT and anti-
retroviral treatment (ART) up-take among health workers and their partners.
FY08 funds will be used to support the University of Washington and its partner Global Health
Communications (GHC) to assist the MOH team to identify appropriate methods for facilitating behavior
change among health workers and their partners, develop an action plan for conducting appropriate
interventions to support health workers in reducing risk behaviors, pilot and design interventions, explore
use of community radio to reach rural workers and create an environment conducive and supportive to
changes of health worker behaviors and attitudes. In addition, interventions to reduce barriers to use of CT
and ART services among health workers such as for example mobile units for counseling and testing will be
explored and piloted. Finally, the technical assistance provider will work with teachers and students at MoH
training institutions to design and pilot interventions at pre-service training institutions where young doctors,
technicians and nurses are currently undergoing training. Specifically, activities the partner will support in
a) Collaborating in the design and conduct of a "structural review" of workplace counseling and testing
programs in Botswana and Tanzania and possibly other countries in the region that will analyze activities
currently undertaken in those countries with an eye towards how successful elements can be recombined
and applied to the Mozambican context;
(b) Providing technical assistance to MoH in applying quantitative and qualitative assessment findings to the
task of designing behavioral and informational interventions with the aim of increasing CT uptake;
(c) Assisting in the development of behavioral and educational interventions focused on issues CT;
(d) Training local implementing partners and stakeholder in implementing (and subsequently piloting) CT
(e) Assisting MoH in evaluating CT pilot interventions.
The second component ($75,000) is proposed to support the following activities: Sex work in Mozambique
is driven largely by the lack of employment opportunities, and facilitated by the demand of migrant and
mobile laborers, as well as members of the general population (World Vision, 2005). Young women are at
particular risk; the age of sexual debut in Mozambique is low (15.4 years) and the mean age for women
entering sex work is 17.8, with an age range of 9-28 years (World Vision 2005). Younger women are also at
increased risk for STI and HIV acquisition because of biological changes in the cervix that take place
between puberty and adulthood (Berman and Hein 1999). While the extent of drug use among sex workers
is not known, a 2004 survey reported that 13% (15/111) of female sex workers used drugs, including
cocaine, up from 7.4% in 2002 (World Vision 2005). Another study has documented drug dealers as
frequent clients of sex workers in the Maputo corridor area (Wilson 2001). These factors indicate that the
potential for increasing drug use among sex workers and mixing of sex worker and drug using populations
exists, and may serve to spread HIV further into the general population. In response to this situation,
Mozambique's International Rapid Assessment Response and Evaluation (I-RARE), supported through
USG funding from FY06/07, has been designed to better understand, assess, and make recommendations
for how to respond to rapidly changing sexual risk and drug using patterns that increase vulnerability to HIV
infection among sex workers and drug users in three cities in Mozambique, Maputo, Beira, and Nacala
Porto, Mozambique. One of the foci of this assessment is the identification and description of the range of
available counseling and testing (CT) services for sex workers and drug users as well as the understanding
of the personal, social, and environmental barriers that sex workers and drug users perceive as inhibiting
access to CT services. Service providers' perspectives on CT availability and access are also important,
and this activity is aimed at assisting them in making CT services more desirable and convenient. FY08
funds are being requested to support the University of Washington/GHC to undertake the development,
implementation, and evaluation of prevention activities relating to at risk populations. Activities that this
partner will support in Mozambique include:
(a) Supporting local partner in developing outreach programs and possibly bar and other drinking venues
where alcohol consumption and sexual mixing may present opportunities for targeted CT interventions. In
addition to CT, such interventions may deliver a range of informational and behavioral content. This activity
may also include reviewing models of CT processes and procedures based on the South African rapid
(b) Training NGO/CBO and government agencies to pilot outreach and intervention activities that connect
sex worker and drug/alcohol-using population to CT; and
(c) Coordinating local stakeholders and CDC technical assistance as they develop monitoring and
evaluation protocols and formats for CT that are consonant with best practices in Africa and elsewhere.
I-TECH has been committed to providing technical assistance to the Ministry of Health in support of their
ambitious HIV program expansion plans. ($1,686,000)
In 2008, in partnership with MISAU, I-TECH will establish a training center in one of the MISAU / PEPFAR
focal provinces (Sofala, Zambezia or Nampula, TBD), linked with one of the Ministry's pre-service training
centers. The new training center will offer a range of training support services to the Mozambique and will
establish a link between pre- and in-service trainings.
In COP 08, I-TECH will continue its support to MISAU through the provision of technical assistance and
training to conduct a number of critical HIV-related initiatives, including the rollout of a Pediatric ART course,
country-wide; validation research related to opportunistic infections; and the development of a pre-service
curriculum for TdM, including, for the first time, HIV-related topics in the course.
I-TECH's COP 08 objectives are as follows:
Objective 1: Provide training and support to mid-level health workers in the provision of ART and PMTCT
Objective 2: Increase the capacity of mid-level practitioners to provide pediatric ART services
Objective 3: Provide support for OI validation research
Objective 4: Provide technical support to MISAU in the development of the TdM pre-service curriculum
Objective 1: Provide training and support to mid-level health workers in the provision of ART and PMTCT
services. In 08, I-TECH will establish a training center in one of the priority provinces (Sofala, Zambezia or
Nampula) in order to better support a range of training services in the region.
Activity 1.1. In a selected province, work with the training institute, provincial training unit, NGO partners,
clinics and hospitals to establish a training center with a regional focus, which would offer a range of training
services, for example, refresher courses for clinicians; trainings for trainers and mentors on a range of HIV-
related topics; and workshops on curriculum development and training methodology. The center would link
pre-service and in-service activities, and didactic and hands-on training.
Activity 1.2. Provide individualized capacity building assistance to training partners in assessing, planning,
organizing, implementing and evaluating HIV-related training activities through assistance from specialists
based at the center.
Objective 2: Increase the capacity of mid-level practitioners to provide pediatric ART services. In 2008, I-
TECH will assist MISAU in rolling out the pediatric ART in-service course for mid-level providers country-
Activity 2.1. Revise the pediatric ART curriculum and training materials based on the pilot course evaluation.
Activity 2.2. Plan, coordinate and facilitate the national roll-out of the Pediatric ART training: conduct two
national Training of Facilitators courses for MISAU trainers (2 facilitators per province); facilitate one training
per province (x 11 provinces) with MISAU trainers. Conduct training evaluations; adapt materials as
Objective 3: Provide support for OI validation research through the development of a validation proposal,
and pilot of the OI component of the Basic Course on HIV.
Activity 3.1. Serve a supportive role (TBD) in the implementation of 07 proposal for validation research
related to the opportunistic infection (OI) guidelines.
Objective 4: Provide technical support to MISAU in the development of the TdM pre-service curriculum. In
2008, I-TECH will provide technical assistance to MISAU to support them in the management of the phased
development of the TdM pre-service curriculum, envisioned to be a multi-year project.
Activity 1: I-TECH will assist MISAU's Training Unit and Technical Working Group to lead and manage a
phased approach to expanding the course outline by developing the content of the TdM pre-service course,
first prioritizing prerequisites needed for HIV and related courses. I-TECH will collaborate and/or
subcontract with international or regional training institutions to develop the course content. The amount of
course material able to be developed will depend on depth/complexity of a standard module (TBD).
Funding may include related costs of the working group.
This activity sheet also proposes funding ($50,000) for the following activities: The MoH currently provides
its workers with free ARV treatment and, according to the MoH, as of May, 2007 ARVs were available in
146 sites covering all 128 districts of Mozambique (and all ARV service sites are integrated with counseling
and testing services). As with accessing other HIV-related services, however, it is unclear that among HIV-
infected and eligible health workers uptake of, and adherence to, ARVs is at an optimal level and what
could be done to improve this situation. According to anecdotal information, concerns around confidentiality
of information and fears of discrimination within one's work environment are concerns of health care
workers when considering whether to access treatment. These concerns present significant barriers for
health workers to accessing ARVs but it is unlikely that increased access to ARV services can occur without
both a clearer understanding of service-seeking behavior and subsequent efforts to address informational
and behavioral gaps. This understanding will be based on the quantitative and the qualitative health
workers studies currently being undertaken and supported through FY06/07 funds. FY08 funds are being
requested to support the University of Washington and its partner Global Health Communications (GHC)
with experience in the successful development and evaluation of Behavior Change Communication (BCC)
interventions in the African context. Activities that this partner will support in Mozambique include:
(a) Providing technical assistance to MoH in applying quantitative and qualitative assessments to the task of
BCC intervention design with the goals of improving access to ARVs, facilitating uptake of ARV services,
and promoting adherence to ARV regimes;(b) Guiding the development and piloting behavioral and
educational interventions focused on issues of ARV access and adherence; and (c) Assisting MoH in
evaluating pilot interventions relating to ARV access and adherence.
(b) Guiding the development and piloting behavioral and educational interventions focused on issues of
ARV access and adherence; and
(c) Assisting MoH in evaluating pilot interventions relating to ARV access and adherence
FY07 COP activity number linked to PHE project : 8802
Title: Targeted Evaluation of ARV Training Course in Mozambique.
Time and money summary: this is a 07 COP activity, expected to be complete in early 2008; original budget
request in 07 COP was $88,000; we now estimate that $100,000 will be expended on the actual evaluation.
No funds are requested in 08 COP for the evaluation, but rather follow-on activities, to include the revision
of the TARV course (see below).
Local Co-investigator: several individuals at the MOH's National Department of Medical Assistance are
involved in this project, headed by Dr. Americo Assan
Project description: CDC and the Mozambican Ministry of Health (MoH) supported a new course to teach
Mozambican mid-level health practicioners (tecnicos de medicina) to prescribe and manage active
anetiretorviral therapy (ART) for HIV patients. The two-week course includes classroom and practical
components. The primary purpose of the evaluation in 2007 is to assess to what extent course graduates
adhere to the guidelines taught in the course once they return to their work sites. Secondary questions are:
Do course guidelines address the clinical questions most commonly encountered by the graduates? Are
the guidelines learned by the graduates consistent with other guidelines currently in force in their work
sites? Are the course graduates' working conditions conducive to guideline adherence? The anticipated
outcome is a series of recommendations for revision or updating of the course curriculum, clinical
guidelines, and/or post-course support and supervision systems. The study design will incorporate
structured observation of course graduates as they attend patients in their usual work sites. The study will
use two instruments, one for HIV-infected patients not yet on HAART and one for patients already on
HAART. The structured observations will be supplemented by brief semi-structured interviews with course
graduates and site supervisors. A convenience sample of course graduates will be generated using training
lists and by consulting with provincial and local health authorities where the course graduates work. We will
aim for a sample of 40-50 graduates and will plan to observe one new HIV patient and one patient already
on HAART for each graduate.
Status of study/progress to date: Protocol was initially presented to MOH in November 2006 and approved
by MOH bioethics committee in early July 2007. CDC Atlanta is in the process of reviewing protocol. The
evaluation scheduled to take place in October-November 2007. Data analysis and reporting should be
completed by January 2008. The follow-on activity to this evaluation is the revision of the ARV course based
on the evaluation results, and the design and implementation of two training of trainer courses to roll it out.
The revision of the course was originally included in COP 07, but will likely be carried into COP08 due to
Lessons Learned: to be included in final report
Information Dissemination Plan: The primary audience for the evaluation results is comprised of the
Mozambican Ministry of Health and the institutional partners currently assisting the Ministry in
implementation of public-sector AIDS-related training and patient-care programs. This audience is internal.
However, should the evaluation yield results that might be of interest to other Ministries of Health or
PEPFAR implementers, we would consider presenting them orally (at professional meetings) and/or in
writing (through peer-reviewed scientific journals), depending on the specific nature of the findings.
Planned FY08 activities: Build the capacity of MOH staff and provide them with technical guidance to adapt
and relaunch the TARV course based on the results of the evaluation. The course will be principally used as
in-service refresher trainings for TdMs, their supervisors, and other mid-level practitioners. Conduct 2 TOTs
for implementing agencies to roll out the course.
Budget Justification for FY08 monies (please use US dollars):
Salaries/fringe benefits: $30,000
• Final report on ARV Training Course in Mozambique
• Discussion around results and implications for national policy and procedures
August08 Reprogramming: Funding increase $140K. Ministry of Health has indicated that they are not
interested in developing this type of training facility as they are seeking investmetn in longer term training of
health care workers versus short term courses. Use of technology for training health care workers and for
support/retention of existing health care workers are being considered. A memorandum of understanding
that includes introuction of distance learning was developed with FIOCRUZ and the Ministry of Health.
What remains unknown is the current state of technology for education within Mozambique, both in
infrastructure and human capacity. This reprogrammed money would be used to inventory distance
learning, assess capacity of existing training institutions, assess attitudes toward use of technology for
health care workers, and recommend potential uses.
I-TECH has been committed to providing technical assistance to the Ministry of Health in support of their
ambitious HIV program expansion plans. In FY06 and 07, I-TECH focused on assisting MISAU to develop
and standardize its pre-service and in-service courses in order to improve the knowledge and skills of the
clinicians serving in the National Health Service. To that end, I-TECH assisted in the development of an in-
service ART ("TARV") course for técnicos de medicina (TdM). I-TECH trained the course facilitators,
evaluated the training and modified the course content, and performed clinical observations of a sample of
TdM who received the in-service ART course. I-TECH also developed and piloted the first pre-service HIV
training materials for TdM, covering the topics of AIDS, TB, OI, malaria and malnutrition in order to better
prepare them for diagnosing and managing HIV-infected cases. In tandem, I-TECH began a series of
trainings for TdM pre-service teachers to assist them in delivering high quality education to their students,
as well as working with implementing partners, supporting them in a range of in-service mentoring and
In 08, I-TECH proposes to build on the previous year's work by providing capacity building assistance to
MISAU and implementing partners to develop and roll out effective and consistent pre-service and in-
service training programs. I-TECH's COP 08 objectives are as follows:
Objective 1: Strengthen capacity of the faculty in the pre-service training institutions to deliver high-quality
training in HIV/AIDS and related topics to health workers.
Objective 2: Strengthen the capacity of health care workers to deliver quality HIV care and treatment
through in-service training and mentoring programs.
Objective 3: Provide technical assistance to MISAU and its training institutions to improve and standardize
their national training systems and materials
Activities and Expected Results:
In 2007, I-TECH conducted initial training of the faculty of the Institutes of Health Sciences who teach TdM
pre-service courses. The results of the trainings indicated that the faculty of the different institutes required
different levels and types of support, and that the teacher skills, knowledge and attitudes varied
considerably. For this reason, I-TECH requests the flexibility in 08 to develop a series of trainings for the
faculty of the training institutes which responds to particular institutional needs, which would be jointly
defined, and which ensures a minimum skill and knowledge level of all TdM teachers.
Activity 1.1: Work closely with the faculty of the 7 institutes that train TdM to develop comprehensive
capacity building programs based on the institutes' individual needs, so that the faculty are skilled in
delivering the current TdM Plano Analitico and new curriculum (including ATOMM) as it evolves over the
next few years. Training would include participatory teaching methodologies, developing student practica,
and the introduction of a variety of innovative and effective methodologies to respond to the operational
realities of the TdM (as documented in the TdM clinical observation study for the TARV course). May
include financing for covering costs associated with conducting courses outside of normal academic year.
In 2007, I-TECH updated the ART course for in-service TdM based on a country-wide clinical observation,
and developed a mentoring program to ensure on-site support. I-TECH assisted ICAP in developing an in-
service nurse-mentoring program for those involved in PMTCT. I-TECH also developed and piloted the OI
section of the in-service training course "Basic Course on HIV". Based on the best practices of these 07
activities, I-TECH will continue to expand and strengthen the provision of in-service training and mentoring
programs for clinicians in 2008.
Activity 2.1: Subsequent to the 07 activity to revise and pilot the OI portion of the in-service course, "Basic
Course on HIV", adapt the course for 3 cadres of health workers (TdM, medical assistants and referral
nurses), and conduct 3 TOT for implementing agencies to roll it out.
Activity 2.3: Conduct refresher courses for all cadres of health workers, as appropriate, particularly in the
instance of the development of new guidelines, new practices, or for addressing general concerns relating
to clinical practices as identified by MISAU. Estimated 2 five-day trainings in each of the three focal
provinces (Sofala, Zambezia & Nampula) on various HIV-related topics.
Activity 2.4: Building on an 07 clinical mentoring pilot for TdM, provide technical assistance to partner
organizations for designing and developing mentoring of mentors program (MOM) in two sites.
their national training systems and materials.
Building the capacity of MISAU is critical to the sustainability of HIV-related training and support activities,
and is the most effective way in the long term of ensuring standardized, high quality health care services. It
is MISAU's mandate to lead the country in the medical response to HIV, and to ensure that its institutes, as
Activity Narrative: well as all the implementing partners, train health care workers using the same guidelines, standards and
To assist MISAU, I-TECH placed a curriculum specialist in the MISAU training department part time in 07,
whose main function was to train, mentor and technically support MISAU staff in their efforts to develop
standardized training curricula, materials, methodologies, implementation techniques, and evaluations,
whereby ensuring consistent and effective pre-service and in-service trainings. In 08, I-TECH will continue
to provide hands-on assistance to MISAU.
Activity 3.1: Mentor the Training Unit staff in strengthening their skills for developing guidelines, templates,
principles and standards for curriculum development and training design to ensure consistent and effective
programs across their training institutes.
Activity 3.2: Act as lead agency and provide technical assistance to the trainers at MISAU Central Training
Unit, the DPS Training Units, and partner organizations in the support of the roll out of various training
programs. This includes the dissemination of standardized curriculum guidelines and templates, as well as
standards for training methodology, implementation, and evaluations.
• Pre-service faculty development in HIV/AIDS and related topics
• Standardized template for pre-service educational modules
• In-service training and mentoring programs
• Materials adaptation
• Training of trainers
• Technical assistance to MOH and its training institutions
• Curriculum specialist working part time at the MOH to mentor training department staff
• Establish lead training agency that will provide technical assistance to the trainers at MOH, DPS Training
Units and partner organizations in the roll-out of various training programs