The overall goal of this activity is to strengthen the community-based response to the HIV epidemic in Mozambique through using an integrated approach that includes: 1) Providing community-based HIV services, including TB detection and effective referrals to facility-based health and social sector services (maternal/child health (MCH), reproductive health (RH), TB and HIV testing and treatment; 2) Improving and expanding access to economic strengthening activities for affected families; and 3) Enhancing the public sector's capacity to provide an integrated continuum of care and support for affected households and individuals. It is expected that local organizations, through intensive capacity-building and mentoring, will be equipped to effectively respond to the needs of PLHIV and OVC with local solutions and resources to improve their quality of life. Objective 1: Increased provision of quality, comprehensive community-based care and support services to PLHIV and their families. Objective 2: : An effective, coordinated response among the MMAS, MOH, and civil society organizations (CSO) for delivery of family-centered, community-based services which will improve health outcomes and quality of life for PLHIV and OVC. Objective 3:: HIV affected households have adequate asset base which allows them to effectively absorb the shocks brought on by this chronic illness. Objective 4: Increased access to and demand for MCH/prevention of PMTCT services through community outreach. This activity will target OVC, PLHIV, and pregnant and lactating women at community level.

In FY 2010 this activity will be implemented in the following provinces with varying degrees of coverage: in Maputo, Inhambane, Manica, Sofala, Tete, Niassa and Cabo Delgado, . Level of coverage in each province will depend upon the existence of other USG activities implemented through this request for task order proposals (RFTOP) contribute directly towards the Partnership Framework goal to ensure care and support for pregnant women, adults and children infected or affected by HIV.

All of these activities contribute to Goals 1, 3, 4 and 5 of the Partnership Framework. These community- based interventions in prevention, civil society strengthening, economic strengthening and nutrition are aimed at increasing demand for facility based services, ensuring the continuum of care, preventing new

infections and improving the quality of life of PLHIV and OVC.

Gender will underscore implementation of all activities by addressing barriers which limit access to services and place the burden of care on women and girls. Boys and men will be meaningfully engaged in identifying and addressing these barriers.

Economic strengthening activities are aimed at reducing household vulnerability brought on by HIV. Emphasis on nutrition education/counseling (vs. food commodity provision) and appropriate technologies (i.e. conservation farming) will improve nutritional status and food security of beneficiaries. In partnership with Population Services International, beneficiaries will access safe water treatment systems, hand- washing soap and hygiene education.

The Presidential Malaria Initiative is providing long lasting insecticide treated nets (LLIN) to all antenatal care (ANC) sites and for all children under 5; ensuring that the most vulnerable access protection from malaria. As appropriate, beneficiaries will be referred to counseling for RH/FP services.

To ensure improved coordination the contractor is required to provide a specific statement on collaboration and the use of joint work-planning with other USG and non-USG implementers to harmonize activities and avoid duplication. Sites prioritized for implementation are within catchment areas of USG- supported clinical partners to facilitate more effective, bi-directional referrals.

Strategic partnerships with private sector and coordination with other implementers to ensure complementary programming will help to increase coverage of services and minimize USG costs.

This activity will focus on building the technical and organizational capacity of local organizations to

effectively provide family-centered, community-based care and support services to households with

PLHIV in Maputo, Inhambane, Manica, Sofala, Tete, Niassa and Cabo Delgado.. Home Visitor will

ensure that PLHIV have access to the range of care services (cotrimoxazole prophylaxis (CTXp),

tuberculosis (TB) treatment, CD4 testing etc) as required. Activities that link with OVC programs to

ensure access to basic care and support services are essential to improving quality of life throughout the

continuum of HIV infection. In Mozambique a study showed that the most frequent challenges to ART

adherence are social and economic in nature (i.e. food and nutrition security, lack of transport). The

contractor will work with ART facilities in catchment area to identify beneficiaries. The contractor will

support implementing organizations/PLHIV associations create village savings and loans, access micro-

credit, to reduce the economic vulnerability of the household and barriers to treatment adherence.

Positive prevention support groups at community will be established where possible with ART/pre-ART

patients who live close to each other.

This activity will focus on building the technical and organizational capacity of local organizations to

effectively provide family-centered, community based care and support services to vulnerable children in households affected by HIV in Maputo, Inhambane, Manica, Sofala, Tete, Niassa and Cabo Delgado.. Activities will help to ensure that OVC have access to basic essential services 1) food and nutritional support; 2) shelter and care; 3) protection; 4) health care (including for HIV positive children; 5) psychosocial support; 6) education and vocational training; and 7) economic opportunity and strengthening. Contractor will support implementing organizations to integrate activities into the National Action Plan for OVC, and collaborate closely with district and provincial MMAS to ensure compliance with minimum service standards defined by the Ministry. This activity will work in close collaboration with clinical partners and existing community structures to ensure that the most vulnerable households with children are identified. An important focus of this activity is to ensure viable skills training and economic strengthening for older OVC to ensure that they are able to be self-sustaining upon 'graduation' from a USG-supported program.

To better understand the kind of services that OVC most need, Mozambique is requesting that data reported be disaggregated by service to better inform program priorities over time.

This activity is the community-based component of a comprehensive program that seeks to prevent mother-to-child transmission of HIV and will contribute to the MOH's goal of a national PMTCT program that is fully integrated into ante-natal care (ANC) services. This activity will be implemented in in Maputo, Inhambane, Manica, Sofala, Tete, Niassa and Cabo Delgado provinces. Sites prioritized for this activity will be USG supported and with a large volume of PMTCT clients.

Women receiving facility-based PMTCT/ANC will benefit from the support of care and support services (as applicable) and peer and psychosocial support at community level from mothers who have successfully navigated PMTCT/ANC services themselves. Referrals for and counseling about family planning/reproductive health (FP/RH), HIV prevention, safe water and hygiene will also be available to women. This community-based support will improve adherence and facilitate clinical partners' ability to track women (and their children) who have been lost to follow-up and promote male involvement, while respecting cultural norms.. As there will be a strong link and coordination with USG clinical partners, an increase in HIV testing, uptake for FP/RH services, uptake to highly active antiretroviral therapy (HAART) can be tracked.

Women and their children will benefit from strengthened nutrition counseling as well as receive support

for learning how to use locally available foods to create nutrient-rich foods for their families. Economic strengthening activities targeting vulnerable households will allow heads of households to access health, education and other essential services for their children.