Programs

FHI Programs in Mozambique

OCTOBER 2007 — Since 2002, FHI has been implementing USAID-funded prevention, care, and support activities in Mozambique, working with our partners and Mozambican counterparts to provide integrated HIV/AIDS prevention, care, and treatment services that address the country's high prevalence rate, particularly among women and children.

Current programs build on ongoing efforts to provide high-quality services and reduce the country's high HIV prevalence rate. They aim to achieve the following targets set by the President's Emergency Plan for AIDS Relief (PEPFAR): preventing 500,000 new infections; providing care and support for orphans and other vulnerable children and to 550,000 people living with HIV and AIDS; and providing antiretroviral therapy to 110,000 HIV-positive persons.

The HIV/AIDS Care and Support Project

On June 17, 2007, USAID provided funding of $4.3 million through the HIV/AIDS Care and Support Project in Mozambique, which is to be implemented between June 2007 and June 2008. This funding allows work begun under the USAID-funded Implementing AIDS Prevention and Care (IMPACT) Project to be continued and expanded, along with the excellent collaboration established between the Provincial Directorate of Health (DPS) in Zambézia and FHI's experienced field team based in Maputo and Quelimane.

The HIV/AIDS Care and Support Project strengthens and enlarges FHI's integrated model of prevention, care, and treatment services in Zambézia Province—one that can be replicated  throughout the country. The model includes prevention of mother-to-child transmission (PMTCT), counseling and testing, and palliative care; and it integrates prevention, STI management, and maternal and child health into HIV/AIDS care and treatment.

Through this project, FHI is providing targeted technical assistance, training, material support, and capacity building that assist the Ministry of Health's efforts to expand and integrate HIV counseling and testing at all service points, including prenatal care, maternity wards, and STI services. In addition, FHI's partnership with the DPS in Zambézia is significantly enhancing local capacity to provide integrated PMTCT and counseling and testing services as entry points to care, treatment, and support. To this end, the number of professionals trained in counseling and testing is being increased, and community members are being sensitized to the importance of knowing their serostatus.

The activities undertaken advance the following key objectives:

• replicating FHI best practices to expand PMTCT services in ten existing sites and seven new sites
• reinforcing existing counselling and testing sites and add ten new sites
• improving palliative care through support and reinforcement of community organizations, expanded home-based care services, and technical assistance and support
• integrating STI, TB, and HIV services
• building the capacity of local organizations to sustain interventions and strategies

Palliative Care in Mozambique: Quality Assurance and Policy Development

FHI is implementing this project to facilitate the coordination and expansion of quality palliative and home-based care (HBC) services in Mozambique. Tools and policy recommendations are being crafted that foster quality HBC services and community approaches to palliative care, along with the integration of supervision and technical assistance from the formal health system. The project also seeks to link people living with HIV and AIDS to services, including antiretroviral therapy, PMTCT, counseling and testing, and programs for children.

Capacity building is a core component of FHI's technical assistance. Its participatory approach involves Mozambican leaders and stakeholders in HBC in all stages of research, documentation, and tools development.

The project's objectives include

• assessing the quality of HBC practices being implemented by nongovernmental organizations
• developing evaluation tools to inform quality improvement of HBC programs
• developing and adapting training guidelines for HBC and palliative care that are appropriate for different types and levels of service providers and the Mozambican context
• recommending policy modifications that support the implementation and expansion of best practices in HBC and palliative care

PEPFAR funding for the project is made available through the Centers for Disease Control and Prevention (CDC). FHI/Mozambique is carrying out the project under the direction of the CDC, and in close collaboration with the Ministry of Health and other partners and stakeholders.

Tuberculosis Control Assistance Program (TB CAP)

TB control and TB/HIV programs in Mozambique are critically important, since the country's estimated incidence of TB is about 460 cases per 100,000 people. The USAID-funded, five-year TB CAP program in Mozambique addresses the technical challenges that affect TB diagnosis and control in the country, including limited human and lab resources and weak coordination between partners. FHI is one of eight partners engaged in this program, including the KNCV Tuberculosis Foundation, Management Sciences for Health, WHO, the CDC, the American Thoracic Society, and the Japanese Anti-Tuberculosis Association.

One of the first project activities was a baseline assessment in the four priority provinces of Nampula, Zambézia, Gaza, and Sofala. FHI also worked on building capacity and renovating regional laboratories in Beira and Nampula, and is providing technical assistance on new guidelines for the National Laboratory Program to improve and maintain lab-service quality. The project has also distributed 25 new binocular microscopes for direct sputum-smear examination and 215 slide-storage boxes.

The project also seeks to introduce and expand community-based, directly observed treatment, short course (CB-DOTS). To this end, CB-DOTS training curricula and modules have been tested and developed, trainers trained, and a strategic plan drafted. TB CAP has also piloted CB-DOTS activities in the provinces of Gaza, Zambézia, and Sofala, and provided technical assistance in the form of training modules; curricula; and information, education, and communication materials. 

TB/HIV guidelines and training modules that TB CAP reviewed and adjusted have been approved for dissemination by the Minister of Health, including training modules for community volunteers, TB treatment guardians, health workers, and counselors. Leaflets on TB/HIV for TB patients, people living with HIV and AIDS, and TB provincial supervisors and counselors have also been produced.

To provide HIV counseling and testing in health centers where TB patients are diagnosed, TB CAP, in collaboration with JHPIEGO, participated in national training of trainers, as well as the training of TB program staff in priority provinces. TB CAP is also working on a TB/HIV monitoring system and referral forms, and is testing algorithms to improve TB screening of HIV patients and referral mechanisms.

FHI Extends U.S. President's PMTCT Initiative

With support from the U.S. President's PMTCT Initiative, FHI has been establishing interventions for prevention of  mother-to-child transmission of HIV in Zambézia. Although the province is home to about 20 percent of the national population and ANC surveillance indicates that HIV prevalence among pregnant women is over 15 percent, the province had no PMTCT program prior to FHI's involvement. At the request of the government, FHI provided technical assistance in the start-up and implementation of PMTCT services in this region.

FHI is working to establish PMTCT as a part of the maternal and child health services at the Provincial Hospital and September 17th Health Center in Quelimane and the Rural Hospital and Mocuba Health Center in Mocuba District.

FHI supported the following activities, in collaboration with the Zambezia DPS:

• Formation of a DPS-led provincial PMTCT working group to help address local needs in applying the national PMTCT strategy and ensure that the delivery of services fits within the national Integrated Health Networks strategy.
• PMTCT orientations and trainings.
• Needs assessments in FHI-supported health facilities to prepare the sites for PMTCT services, including the provision of commodities, equipment, renovations, and additional staff to provide on-site voluntary counseling and testing.
• Coordination of a study tour to PMTCT sites in Kenya to learned about programs implemented by FHI/Kenya and the Elizabeth Glaser Pediatric AIDS Foundation.
• Joint development,with local implementing partners, of a provincial behavior change communication (BCC) strategy for PMTCT.
• Creation of mother-to-mother support groups in Zambezia
• Development of data collection and analysis systems for program monitoring, evaluation, and quality assurance.

FHI also coordinated with the DPS, Medecins Sans Frontières (Doctors without Borders), and the private sector to expedite the availability of nevirapine for PMTCT services in the province.

BCC Survey Leads Mozambique Strategy

FHI, in partnership with World Vision International and the DPS, conducted a BCC survey in Zambezia Province to document local knowledge and beliefs about HIV and reproductive health practices and identify how to address community needs more effectively.