Clinical Cascade

oCS questioned how PEPFAR collects data for HTC.

One individual can be tested more than once. Difficult for PEPFAR to measure how many times a person got tested.

oCommunity Testing

CS presented concerns related to the level of community testing, that they consider that is too low.

PEPFAR team explained that improvements have been happening, and that that there were good results in index case testing at the community level during Q1 if compared with previous reporting periods

oLost to follow-up/treatment adherence represents a great concern for the CS

CS recommended that PEPFAR and MISAU should have a meeting involving SC and try to define strategies to reduce lost to follow-up and increase patient’s adherence to treatment

MISAU held a meeting recently, and SC was involved (not all apparently). But PEPFAR recognizes the need to improve patient’s adherence to treatment, and agrees that SC plays an important role towards this objective.

CS defends that there’s a need of improving activities around treatment literacy/education, especially in the context of Test and Start.

CS wants PEPFAR to increase availability of funds for treatment literacy activities, and recommends that this activities should be implemented by local SC organizations. SC wants PEPFAR to increase availability of funds for the Mozambican SC organizations.

oPMTCT

CS asked what is the implementation level of the Option B+ strategy at the PEPFAR supported sites.

PEPFAR team explained that not all the health facilities are currently implementing the strategy, although the majority is. The recommendation is to have this strategy implemented in all PEPFAR supported facilities by the end of COP16 implementation. Strategies, such as mobile clinics, will help achieve this objective in the HF with lack of capacity to implement Option B+.

CS demonstrated concern regarding the levels of ART adherence among pregnant women, and recommended increase of treatment literacy as a solution.

PEPFAR team recognized the historical challenge that adherence represents among pregnant women, but explained that stigma and discrimination is one of the major barriers that HIV+ women face in their communities, and recommend that CS should get more involved to help the country respond to this challenge.

CS asked what is PEPFAR doing to increase Male Engagement through PMTCT activities

NOTE: prepare slides explain action plan for Male Engagement for next presentation

oVMMC

CS recommend that the program should be expanded and cover infants (0-10)

Key Population

oCS considers that Mozambique is not prioritizing KP as it should.

oCS recommends a greater coordination with Global Fund to leverage funds impact.

NOTE: For the next presentation, need to include slides explaining what we are doing and the impact of our activities.

System Support – Data collection

oCS asked for PEPFAR to explain what is being done to improve the capacity of the National Health System to collect reliable data, given the traditional difficulty that the country experiences in this area.

PEPFAR team provided brief explanation about the different support that is currently being provided to collect data: EPTS, data clerks, etc

PEPFAR team explained that COP17 will prioritize/increase health informatics system i capacity, and increase its harmonization.

The meetings with Civil society will be handled quarterly for data sharing and comments;

The CSO noted a weak preparedness from the community side for T&S in terms of Literacy for treatment. It was highlighted that the community should be prepared to support patients on behavior change;

There is a need to make use of studies like the stigma index to analyze the data and prepare specific actions for the community focusing not only on access to health but also socioeconomic factors to strengthen adherence and retention in treatment;

CSOs should build capacity for better delivery on literacy for treatment and use guidelines such as the MISAU’s “Literacia para o Paciente” that will come out in June;

There’s a need to strengthen male engagement at community level to reduce stigma for positive pregnant women and increase their retention on PMTCT;

MISAU has many guidelines that are not being followed as the issue of starting treatment for HIV discordant partners when a mother starts PMTCT;

CSOs are thinking that the age for VMMC should be escalated to early childhood as those children will grow and be at risk of contamination during their adolescence. But it is clear that PEPFAR focus on adolescents is because of the risk they face during that specific period;

CSOs recommend that PEPFAR should follow what is happening with Global Fund in terms of focus on Prevention and treatment and find opportunities where funding could be matched to the complementary funds available with Global fund;

It is recommended that CSOs and CBOs should have standards that define their scope of action and all partners should sign to that as a way to ensure that every CBO follow the same standards for health related projects;

In terms of organizations working in prevention that are not reflected on the current data it was advised that on the next reporting cycle they will be reflected. Next quarterly meeting will cover issues and partners that were not included on the current Q1 data;