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: 2012 2013 2014 2015 2016 2017 2018 2019 2020
The purpose of this agreement is to strengthen the capacity of Mozambiques National Institute of Health to generate scientific and technical solutions for the main public health problems in Mozambique, with special emphasis on HIV/AIDS. Specific Objectives: Laboratory; Establish a National EQA program in Mozambique; Provide accreditation for eight laboratories; Improve laboratory diagnosis of TB; Establish the National Microbiology Reference Laboratory. Objective: Expand access to TB culture and DST in the country; Establish DST for second line TB drugs at the National Reference Laboratory in Maputo. Surveillance: Monitor the trends in the prevalence of HIV; Determine the burden and emergence of HIVDR, based HIVDR-TS and EWI; Identify gaps in the scale up of ART in Mozambique that can lead to emergence of HIV DR. HDSS Support; To determine the specific causes of mortality and the proportion due to HIV. Objective: To use demographic and geographical platforms for routine surveillance, incidence and study of the spatial distribution of HIV and other diseases, health determinants and distribution and impact of services and interventions for HIV and other diseases. HSS: Strengthen the laboratory health system, motivate the staff and retain experts in the public system; Field Epidemiology and Laboratory Training Program; Strengthen the Field Epidemiology Laboratory Training Program (FELTP). Expand the number of outbreak investigations and field placements. Care and Treatment. Objective: Implement hepatitis B surveillance program; Report the frequency of chronic hepatitis B and occult hepatitis. As this is a new program there is no pipeline to consider. There are no plans to purchase a vehicle.
This implementing mechanism will use COP 12 funding to strengthen laboratory quality systems and monitor quality of laboratory testing through the implementation of the following activities:
Establishment of a National Laboratory Quality Coordination Office;
Implementation of the SLMTA training program to prepare laboratories for WHO-AFRO accreditation, including training, supervision, and mentoring;
Implementation and maintenance of EQA programs for CD4, biochemistry, TB smear microscopy, gram stain, syphilis serology, and DNA PCR;
Decentralization of EQA for HIV serology to Provincial level;
Development of a quality assurance and proficiency testing scheme for point of care CD4;
Evaluation of the cost effectiveness of point of care diagnostics;
Establishment of reference laboratory capacity for enteric pathogens and sexually transmitted pathogens, and;
Establishment of a specimen bank for evaluating new diagnostic technologies.
Surveillance
HIV Surveillance is a key tool for monitoring progress towards reducing HIV infections in Mozambique, the first goal outlined in the Partnership Framework. Data from sentinel surveillance are used to produce estimates and trends of the burden and impact of HIV/AIDS in the country.
In 2012, funds will be used to further strengthen the surveillance program at MOH ($300,000), including trainings in surveillance methods for MOH staff, implementing the third round of assessment of PMTCT data for ANC surveillance purposes, and funding the 2013 round of sentinel surveillance in pregnant women (some funding was allocated in FY11). Sentinel surveillance includes development and production of survey instruments, training of central and field staff, shipping of specimens, and contracting of data entry personnel. All laboratory reagents and kits will be procured via SCMS or INS.
Since 2007, HIV drug resistance threshold monitoring (HIVDR-TS) was implemented as part of ANC surveillance. Due to challenges with meeting target sample size in this population, in 2012, additional funds will be provided to conduct HIVDR-TS in a different population.
Three IBBS surveys are being conducted in 2011 with INS participation. Funds are also requested to help MOH integrate the Integrated Bio-Behavioral Survey (IBBS) into their HIV surveillance system ($250,000).
HDSS support
In Mozambique, like in most areas of the developing world, vital statistics, when existing, are weak. In these areas, a considerable number of vital events are missed or improperly registered, impeding the assessment of true population dynamics. Small-area projects may more accurately measure cause-specific HIV morbidity and mortality in these settings.
The Chokwé HDSS site initiated activities in June, 2010, with PEPFAR funding, and currently covers approximately 50,000 residents of Chokwe District though is soon to be expanded to cover about 140,000 residents. This continuing activity will fund fourth year operating costs and core data collection activities for this site ($200,000). Funds are also requested to support the early stages of planning for a second HDSS site in Maputo City ($50,000). PEPFAR funding supports material and human resource development at HDSS sites; PEPFAR funds will not support clinical trials or research projects.
Funds are also requested to implement an evaluation of a pilot of highly active integrated prevention in Chokwe using the chokwé HDSS site. The evaluation will collect data on HIV risk behaviors and HIV infection and will correlate changes over time with scale up of evidence-based prevention activities ($340,000)
Laboratory human resources capacity building
Laboratory capacity and skills are severely lacking in Mozambique. FY12 funding will continue to support the post-graduate training in laboratory sciences of three National Institute of Health personnel. ($45,000)
Field Epidemiology and Laboratory Training Program (FELTP)
The Master FELTP is a CDC supported training model that exists in >30 countries around the world. The FELTP in Mozambique is a collaboration between CDC, GOM, and Eduardo Mondlane University, and consists of a 2-year training program resulting in a Masters degree to build human capacity within the Ministry of Health (MOH) for applied field epidemiology, thus strengthening the epidemiologic and laboratory management capacity of Mozambique. INS funding to FELTP will support field placements (at Chokwé HDSS site and others) and support of Theses, posters and travel to conferences for the trainees ($200,000).
INS 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 quality assurance and quality improvement.
This activity will be two-fold:
1. Quality improvement: in partnership with every provincial lead clinical partner, INS will support testing quality trainings to all counselors and health sector personnel in charge of performing rapid HIV testing. The trainings material is currently being adapted from HIV rapid testing training package by WHO/CDC
2. Revision, improvement and continued implementation of the current External quality Assurance methodology/system : proficiency testing in coordination with the national reference lab (INS).
Both of these activities will be carried out nation-wide, targeting all counselors and health care personnel and they will be complemented by on-going supportive supervision, including direct observation.
Additionally, HVCT will fund the implementation of Highly Active Integrated HIV Prevention (HIP). The primary aim of HIP is to reduce HIV incidence within one or more discrete geographic areas of Mozambique by increasing the uptake of HTC, MC, ART, and PMTCT through program expansion, community mobilization, and strengthened linkage, retention, and adherence services. Positive prevention and MARPs activities will be addressed as well.
