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Mozambique Country Operational Plan (COP)

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Mozambique Country Operational Plan (COP) FY 2015 Mozambique Country Operational Plan (COP) The following elements included in this document, in addition to “Budget and Target Reports” posted separately on www.PEPFAR.gov, reflect the approved FY 2015 COP for Mozambique. 1) FY 2015 COP Strategic Development Summary (SDS) narrative communicates the epidemiologic and country/regional context; methods used for programmatic design; findings of integrated data analysis; and strategic direction for the investments and programs. Note that PEPFAR summary targets discussed within the SDS were accurate as of COP approval and may have been adjusted as site- specific targets were finalized. See the “COP 15 Targets by Subnational Unit” sheets that follow for final approved targets. 2) COP 15 Targets by Subnational Unit includes approved COP 15 targets (targets to be achieved by September 30, 2016). As noted, these may differ from targets embedded within the SDS narrative document and reflect final approved targets. 3) Sustainability Index and Dashboard Approved FY 2015 COP budgets by mechanism and program area, and summary targets are posted as a separate document on www.PEPFAR.gov in the “FY 2015 Country Operational Plan Budget and Target Report.” MOZAMBIQUE 2015 Country Operational Plan Strategic Direction Summary 1 | P a g e Definition of Acronyms ACT Accelerating Children's Treatment Initiative ART Antiretroviral Therapy ARV Antiretroviral drugs CCM Country Coordinating Mechanism COP Country Operational Plan CSW Commercial Sex Workers DREAMS Determined, Resilient, AIDS-free, Mentored, and Safe (DREAMS) Initiative EA Expenditure Analysis FADM Ministry of Defense FSW Female Sex Workers GBV Gender-based violence GFATM Global Fund to Fight AIDS, Tuberculosis, and Malaria GRM Government of the Republic of Mozambique GII Gender Inequality Index HRH Human Resources for Health HSS Health Systems Strengthening HTC HIV Testing and Counseling LTFU Loss to follow up M&E Monitoring and Evaluation MGCS Ministry of Gender, Children, and Social Action MISAU Mozambican Ministry of Health MOF Ministry of Finance MSM Men who have Sex with Men NASA National AIDS Spending Assessment OGAC Office of the U.S. Global AIDS Coordinator OVC Orphans and Vulnerable Children PEPFAR President's Emergency Plan for AIDS Relief PITC Provider Initiated Testing and Counseling PMTCT Prevention of Mother to Child Transmission of HIV PPP Public-Private Partnerships PWID People Who Inject Drugs S/APR Semi-annual or annual performance results SI Strategic Information SIMS Site Improvement through Monitoring System SNU Sub-National Unit (Province, in Mozambique) TB Tuberculosis VMMC Voluntary Medical Male Circumcision WASH Water, Sanitation, and Hygiene WHO World Health Organization 2 | P a g e Table of Contents Goal Statement 1.0 Epidemic, Response, and Program Context 1.1 Summary Statistics, Disease Burden and Epidemic Profile 1.2 Investment Profile 1.3 Sustainability Profile 1.4 Alignment of PEPFAR Investments Geographically to Burden of Disease 1.5 Stakeholder Engagement 2.0 Core, Near-core and Non-core Activities for Operating Cycle 3.0 Geographic and Population Prioritization 4.0 Program Activities for Epidemic Control in Priority Locations and Populations 4.1 Targets for Priority Locations and Populations 4.2 Program Area Summaries 4.2.1 Care and Treatment 4.2.2 Community Involvement in Scale-Up Districts 4.2.3 Preventing Mother-To-Child Transmission (PMTCT) 4.2.4 Site Yield Analysis 4.2.5 Tuberculosis/HIV (TB/HIV) 4.2.6 Voluntary Medical Male Circumcision (VMMC) 4.2.7 HIV Testing and Counseling (HTC) 4.2.8 Key Populations (KP) and Other Priority Populations (PP) 4.2.9 Orphans and Vulnerable Children (OVC) 4.3 Complementarity of COP 2015 with Central Initiatives 5.0 Program Activities to Sustain Support in Other Locations and Populations 5.1 Package of Services and Expected Volume in Other Locations and Populations 5.2 Transition Plans for Redirecting PEPFAR Support to Priority Locations and Populations 6.0 Program Support Necessary to Achieve Sustained Epidemic Control 6.1 Laboratory Strengthening 6.2 Strategic Information (SI) 6.3 Health System Strengthening (HSS) 7.0 USG Management, Operations and Staffing Plan to Achieve Stated Goals Appendices Appendix A: Core, Near-core, Non-core Matrix Appendix B: Budget Profile and Resource Projections Appendix C: Expenditure for Care and Treatment Packages Appendix D: Prevention of Mother to Child Transmission (PMTCT) Additional Information Appendix E: Key and Other Priority Populations Package of Services Appendix F: Sustainability Index and Dashboard 3 | P a g e GOAL STATEMENT The goal of the U.S. Government’s Emergency Plan for AIDS Relief (PEPFAR) country operation plan for 2015 (COP15) is to support the Government of Mozambique (GRM) in setting and maintaining a trajectory to achieve national HIV epidemic control by 2020. In Mozambique, five United States Government (USG) agencies with PEPFAR funding support the GRM's efforts to control the HIV/AIDS epidemic.1 PEPFAR collaborates with the Mozambican Ministry of Health (MISAU), National AIDS Council (CNCS), Ministry of Gender, Children and Social Action (MGCS), Ministry of Defense (FADM), multilateral organizations, and civil society. Meeting the COP15 goal will require advocacy with the GRM to change antiretroviral treatment (ART) policies; review of USG priority sites and services support; a coordinated plan for the transition of low burden sites to the GRM; renewed focus on children, adolescent girls, and young women through the Accelerating Children’s Treatment (ACT) and the Determined, Resilient, AIDS- free, Mentored, and Safe (DREAMS) initiatives; more effective services for key populations; and targeted strengthening of the GRM’s health systems necessary to achieve an AIDS Free Generation. In COP14, 65 high burden districts were identified for intensified action. Located in ten of the eleven provinces of the country, HIV prevalence in these districts is greater than 8% and each has more than 4000 people living with HIV (PLHIV). These 65 districts account for 76% of the national total estimated number of people living with HIV (PLHIV). The programmatic focus of COP14 concentrated on reaching and starting treatment for all eligible HIV-infected persons. Eligible populations include all HIV infected persons with a CD4 level of 350 cells/mm3 or less or a clinical WHO stage of 3 or 4, as well as the following “test-and-treat” groups: children less than 5 years old; those co-infected with tuberculosis (TB); pregnant women; male partners of sero-negative pregnant women; and members of key population (KP) groups (Commercial Sex Workers (CSWs) and Men who have Sex with Men (MSM)). COP15 strategically places intensified efforts on areas of the country with higher epidemic burden and higher unmet treatment needs as we work towards epidemic control. Districts identified as having the heaviest disease burden, greatest unmet need, and the possibility of achieving high ART coverage (defined as 73% of PLHIV on treatment) are at the focus of this plan. We propose to reach ART coverage of 73% of PLHIV within 77 scale up districts (1 district in FY15, 39 by the end of FY17 and 37 by the end of FY18) while simultaneously sustaining the response to safeguard the quality of care and treatment in the remaining 71 districts of Mozambique. HIV Testing and Counseling (HTC) targets and demand creation activities are aligned with treatment targets and focus on the 77 high burden districts in locations with maximum yield. To achieve these ambitious treatment goals which will bring Mozambique closer to epidemic control, PEPFAR will continue to collaborate closely with the GRM to support a change of the CD4 threshold criteria for starting treatment to be 500cells/mm3 or less (from the current CD4<350) to align with 2013 1 The five US Government agencies participating in PEPFAR are the Department of State, Department of Defense, Peace Corps, United States Agency for International Development (USAID), and the Centers for Disease Control (CDC) 4 | P a g e WHO guidelines, as well as expanding the test-and-treat population to include children up to the age of 15 years (currently all children below the age of 5 are eligible for immediate treatment, but not those between 5 and 15 years of age). COP15 also includes a focused prevention approach. As key populations are heavily impacted by HIV and are also important drivers of the epidemic, increased efforts to reach more commercial sex workers, their clients, and MSM are incorporated into this strategy. In addition, the condom portfolio will promote condom use with sero-discordant couples. These prevention programs will be complemented by activities addressing adolescent girls and young women and their male partners, funded through DREAMS and focused in 8 of the PEPFAR scale-up districts. Voluntary medical male circumcision (VMMC) programs are also aligned with the scale-up districts, with a target in COP15 of 271,563 procedures for 58 sites in 47 scale-up districts. Since the launch of the GRM’s first demand creation campaign, the VMMC program has been gaining momentum. COP15 continues to focus on young men for greater efficiency and impact on HIV prevention. VMMC activities will continue in military bases with large numbers of young, uncircumcised men, particularly bases with large numbers of new recruits. The OVC program will focus on the 77 scale-up districts as well as catchment areas surrounding high volume clinical sites. Transition plans for areas outside of the scale-up districts will be developed with the MGCS at the central level and with government counterparts at the district level. An emphasis on family-centered programs, socio-economic support, and more clearly defined core and near-core interventions will be accompanied by improved targeting as well as community testing. OVC programs will maximize impact and efficiency by maintaining strong linkages with both the ACT and the DREAMS initiatives. Mozambique has a fragile and under-staffed health system, which needs strengthening to achieve and sustain HIV epidemic control.
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