Lessons Learned while Implementing an HIV/AIDs Care and Treatment Program in Rural Mozambique

Abstract

Mozambique has severe resource constraints, yet with international partnerships, the nation has placed over 145,000 HIV-infected persons on antiretroviral therapies (ART) through May-2009. HIV clinical services are provided at > 215 clinical venues in all 11 of Mozambique’s provinces. Friends in Global Health (FGH), affiliated with Vanderbilt University in the United States (US), is a locally licensed non-governmental organization (NGO) working exclusively in small city and rural venues in Zambézia Province whose population reaches approximately 4 million persons. Our approach to clinical capacity building is based on: 1) technical assistance to national health system facilities to implement ART clinical services at the district level, 2) human capacity development, and 3) health system strengthening. Challenges in this setting are daunting, including: 1) human resource constraints, 2) infrastructure limitations, 3) centralized care for large populations spread out over large distances, 4) continued high social stigma related to HIV, 5) limited livelihood options in rural areas and 6) limited educational opportunities in rural areas. Sustainability in rural Mozambique will depend on transitioning services from emergency foreign partners to local authorities and continued funding. It will also require “wrap-around” programs that help build economic capacity with agricultural, educational, and commercial initiatives. Sustainability is undermined by serious health manpower and infrastructure limitations. Recent U.S. government pronouncements suggest that the U.S. President’s Emergency Plan for AIDS Relief will support concurrent community and business development. FGH, with its Mozambican government counterparts, see the evolution of an emergency response to a sustainable chronic disease management program as an essential and logical step. We have presented six key challenges that are essential to address in rural Mozambique.

Correlates of Suboptimal Entry Into Early Infant Diagnosis in Rural North Central Nigeria

“…The proportion of mothers who failed to bring in their infant for EID testing is similar to rates reported elsewhere in Nigeria 27 and other parts of sub-Saharan Africa. 28-30 …”

Poor-quality health services and lack of programme support leads to low uptake of HIV testing in rural Mozambique

“…Friends in Global Health (FGH), affiliated with the Vanderbilt Institute for Global Health, partners with the Mozambican Ministry of Health (MISAU) and the Provincial Health Directorate of Zambézia (DPS) to provide HIV care and treatment to people in rural Zambézia Province through a PEPFAR-supported grant from the Centers for Disease Control and Prevention (CDC) [29]. When this study was conducted in early 2009, testing and treatment was offered at the main hospital in each of the 6 districts (Figure 1).…”

“…Intermittent supply shortages of testing kits, anti-retroviral medication, as well as delays in obtaining lab results were common during the initial roll out of services, which began in 2007, negatively impacted the quality of clinical services [29]. Similar problems continue to plague clinical services, and there has been an increase in the number of patients on ART from none in 2007 to 5671 in 2012.…”

Barriers to Male Involvement in Antenatal Care in Rural Mozambique

“…Efforts to re-capacitate the province are only now achieving widespread improvements in health, education, sanitation, and transportation infrastructure (Vergara et al, 2011). One group supporting health capacitation is Friends in Global Health (FGH) (Moon et al, 2010). This international Non-Governmental Organization (NGO) provides HIV technical assistance in Zambézia province to increase ANC uptake, specifically HIV counseling and testing and the timely and appropriate initiation of ART during pregnancy (Ciampa et al, 2012).…”