Lisa J. Nelson, MD MPH MSc UEM / UCSD MEPI External Advisory Board Meeting Maputo

1. President’s Emergency Plan for AIDS Relief (PEPFAR) Lisa J. Nelson, MD MPH MSc UEM/UCSD MEPI External Advisory Board Meeting Maputo March 14, 2011

2. Outline • President’s Emergency Plan for HIV/AIDS (PEPFAR) Overview and Coordination • Mozambique USG-GRM Partnership Framework Goals • PEPFAR Support to Health System Strengthening • Synergies between PEPFAR and MEPI Initiative

3. PEPFAR: the US Response to the Global AIDS Crisis • 2003: PEPFAR was launched • 2008: PEPFAR reauthorized through 2013 • Committed $32 billion through FY2010 • Interagency coordination model

4. PEPFAR Mozambique Organization and Coordination • Interagency initiative lead by U.S. Ambassador • HHS (CDC, HRSA, NIH) • Department of Defense • Peace Corps • Department of State • USAID • Interagency management structures • Coordination Office • Senior Leadership • Technical Working Groups

5. USG-Government of MozambiqueHIV/AIDS Partnership Framework Goals 2009-2014 • Reduce new HIV infections in Mozambique • Strengthen the multi-sectoral HIV response in Mozambique • Strengthen the Mozambican health system, including human resources for health and social welfare in key areas to support HIV prevention, care, and treatment goals • Improve access to quality HIV treatment services for adults and children • Ensure care and support for pregnant women, adults and children infected or affected by HIV in communities and health and social welfare systems

6. Sustainability and Country Led Response Governments and Civil Society empowered to lead, prioritize, implement, and be accountable for a country’s response to HIV/AIDS • Align with GRM priorities • Increase joint planning • Build capacity of national/ provincial systems • Provision of technical assistance, organizational capacity building • Use of government systems • Direct funding to regional governments and local partners • Support quality, sustainable services

7. Developing Efficiencies in Programs • Expanding use of costing studies and modeling • Coordinating our response with the Global Fund and other donors • Identifying, quantifying and disseminating potential structural and program efficiencies

8. Key Partners in Mozambique • Clinical Partners in 11 provinces • Columbia University/ICAP • Family Health International (FHI)/Abt Associates • Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) • Vanderbilt University/Friends in Global Health • CARE • Funding directly to Mozambican institutions • MISAU (2), INS + CMAM • UEM (MPH) • Provincial Health Directorates (2) • M-OASIS • Ministry of Women and Social Action (MMAS)

9. Key Partners in Mozambique • American International Health Alliance (UCLA, ANEMO) • American Society for Microbiology • Universidade Federal do Rio De Janeiro • Food and Nutrition Technical Assistance (FANTA) • Health Systems 20/20 • IntraHealth International • ITECH • JHPIEGO • New York AIDSInstitute (HIVQUAL) • Pathfinder • Partners for AppropriateTechnologies • SCMS • StrengtheningPharmaceuticalSystems (SPS) • Association of Public Health Laboratories (APHL) • AmericanSociety for ClinicalPathology • Clinical Laboratory Standards Training Institute

10. PEPFAR Support 2010 Annual Progress Report • Supported HIV prevention, care and treatment services in all 11 provinces in Mozambique • Provided direct support to >138,000 persons on ART (70% of national total on ART) • Counseled and tested >600,000 persons for HIV in facility-based and community counseling settings • Support prevention of mother-to-child transmission (PMTCT) services at 338 clinical sites (>30% of all PMTCT sites nationally) • Provided HIV counseling, testing and results to >500,000 pregnant women

11. HIV PrevalencebyProvince Cabo Delgado 9.4% Niassa 3.7% Nampula 4.6% Percentagem de mulheres e homens de 15-49 anos com infecção por HIV Tete 7.0% Zambézia 12.6% Sofala 15.5% Manica 15.3% Moçambique 11.5% Inhambane 8.6% Gaza 25.1% Maputo Província 19.8% Maputo Cidade 16.8% Source: INSIDA

12. Health Systems Strengthening • Goal: Strengthen the Mozambican health system, including HR for health and social welfare in key areas to support HIV prevention, care and treatment goals • Increase # of health care and social workers and improve the capacity and quality of pre-service, in-service training, faculty development and post-graduate training • Improve management capacity, motivation and retention of health and social workers • Improve supply chain system at all levels • Health Information System (HIS) • Improve and expand the public health infrastructure

13. USG Systems Strengthening Support • PEPFAR II: focus on HSS • Strong HR component: 140.000 HCW target • Huge infra-structure investments (training facilities, rural health centers, warehouses, lab, etc) • GHI: improve and sustain health outcomes through strengthened HS (beyond HIV) HSS budget in million $

14. Existing Conditions

15. Recent Improvements in Lab Infrastructure

16. Current HIV-Related Lab Capacity in Mozambique • 41 CD4instruments • PIMA point of care CD4 instrument currently in pilot sites in Maputo city (2) Maputo province (2) Sofala (2) and Niassa (2). • Plans underway to expand to 9 sites in Gaza • 4 labsperforming DNA PCR for earlyinfantdiagnosis (EID) • 1 labswithviralloadcapacity

17. Male Circumcision (MC) • 3 clinical trials demonstrated >60% effect in preventing HIV transmission • Completed surgical capacity assessment in 2008 • Pilot project in 6 sites approved by MOH6000 procedures to date • Expanding to 24+ sites in 2011

18. Systems Strengthening – Human Resources • Support the MOH Dept of Human Resources’ (DRH) National Strategic Plan for HR development (PDRH 2008-2015) • Support to MoH in-service training institutions: faculty development and scholarships • Strengthen the Community Health Worker (CHW) program • Support MPH degree in epidemiology and lab (FELTP) at UEM • Support in-service training activities • Strengthen the HR Information System (HRIS) • Mechanisms of Support • Cooperative Agreement with Implementing partners • Direct Technical Assistance (Technical Advisor) to CHW program • Cooperative Agreement and Technical Support to UEM (FELTP)

19. USG Strategic Information - HIS • Support the MOH Dept of Health Information’s (DIS) National Strategic Plan for Health Information Systems (HIS) (2010-2014) • Securing sufficient qualified human resources for the HIS activities at all levels • Improving management of the HIS • Securing appropriate infrastructure & information and communication technology at all levels • Mechanisms of Support • Cooperative Agreement with MOHDIS • Direct Technical Assistance (Technical Advisor) to DIS • Cooperative Agreement and Technical Support to M-OASIS (Mozambique node of Open Architecture and Standards in Information Systems, based at UEM)

20. Areas for Potential Coordination/Synergy with MEPI (1) • Maputo Central Hospital (MCH) • MOH DIS is developing a patient-level medical record system at MCH • CDC support for lab information system (NetAquire) at MCH • Health training institutions • Support faculty development in surgery technicians courses

21. Areas for Potential Coordination/Synergy with MEPI (2) • Strengthening Human Resources in HIS • Coordination of HR development with M-OASIS • Financing courses for Health Statistics Technicians (Técnicos Médios de Estatística Sanitária) at Maputo’s Institute for Health Sciences (ICS) • Responding to for identified HIS needs (e.g. at Provincial level) • Enterprise Architecture • MOH DIS (with M-OASIS support) is in the early stages of developing an enterprise architecture for HIS in Mozambique • Importance of inclusion of various HIS initiatives to ensure overall coordination and ultimately interoperability

22. Key USG PEPFAR Contacts for MEPI Collaboration • Overall Contact: PEPFAR Country Coordinator, April Kelley, kelleyal@state.gov • Human Resources Contact: Shirley Eng-Breard, seng-breard@usaid.gov • HMIS Contact: Strategic Information Branch Chief, Amy Dubois duboisa@mz.cdc.gov • USAID IHO Lead: Polly Dunford, Pdunford@usaid.gov • CDC Mozambique Director: Lisa Nelson, nelsonl@mz.cdc.gov

23. Thank You For further information, please visit: www.PEPFAR.gov