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Title: ArakakiSanchez D'1, Polejack L'1, Mello M1, Lima JN1, Thompson A2, Hoos D'2, El Sadr W2


1
The International Center for AIDS Care and
Treatment Programs
REPÚBLICA DE MOÇAMBIQUE MINISTÉRIO DA SAÚDE
PEPFAR
South to South Collaboration Helps Scale-up ART
in Mozambique
Arakaki-Sanchez D.1, Polejack L.1, Mello M1, Lima
JN1, Thompson A2, Hoos D.2, El Sadr W2 1
International Center for Aids Care and Treatment
Programs, Columbia University, Mailman School of
Public Health, Maputo, Mozambique 2
International Center for Aids Care and Treatment
Programs, Columbia University, Mailman School of
Public Health, New York, United States of America
INTRODUCTION
  • Mozambique is one of the poorest countries in the
    world with an HIV prevalence rate of 16 (see
    Fig.1), it is also one of the ten most affected
    by HIV/AIDS. With a total population of 18.6
    million, it was estimated that, by end of 2005,
    1.56 million people were living with HIV/AIDS.
    About 15,125 of those infected had initiated
    antiretroviral treatment (ART) through various
    partners and the Ministry of Health, with the
    majority in Maputo.
  • In 2005, the International Center for Aids Care
    and Treatment Programs (ICAP) at Columbia
    University, Mailman School of Public Health,
    through funding from the Presidents Emergency
    Plan for AIDS Relief (PEPFAR) initiated HIV care
    and treatment activities in Mozambique. In
    response to the paucity of health care workers in
    Mozambique and the need for rapid scale up of
    services, ICAP developed a South to South
    Collaboration between Brazil and Mozambique with
    the following goals
  • enhance capacity to deliver quality HIV care and
    treatment ,
  • strengthen technical capacity of local clinical
    staff,
  • improve clinic management and patient flow,
  • provide practical experience to young health-care
    providers from Brazil, and
  • promote interest in long term service in
    Mozambique.

Fig.1 National and Regional Prevalence - 2004
9,3
20,4
National Prevalence16,2
18,1
PROGRAM DESCRIPTION
In collaboration with the MOH, ICAP supports
selected Day Hospitals (DH) with the aim of rapid
expansion of HIV care and ART services.
Currently, ICAP provides assistance in 5 out of
11 provinces, and supports 14 DH. The
implementation and roll-out of care and ART
services at the DH is conducted in close
coordination with provincial health authorities.
ICAP provides logistical and structural support
at the Day Hospitals. HIV/AIDS technical
expertise is mainly provided by ICAP Clinical
Advisors, who are based at the DH, working to
support local health care providers. A rapid
growth in the number of patients enrolled has
occurred at all ICAP-supported Day Hospitals.
However, there has been no concomitant increase
in the number of local health professionals
working at these sites, due to a limited health
care workforce. It is estimated that there are 2
physicians and 28 nurses per 100,000 population
in Mozambique. Brazil is the first developing
country to implement a national HIV plan with
universal access to ART. Brazil is a diverse
country with many areas suffering from many of
the same challenges facing the HIV treatment
scale-up program in Mozambique. ICAP launched
a Collaboration between Brazil and Mozambique via
a partnership with Brazilian universities to
enhance patient care and provider knowledge by
inviting Brazilian health professionals for
two-month rotations in Mozambique. Brazil and
Mozambique have a common language, as well as
similar challenges and history. That commonality,
as well as prior linkages between the two
nations, facilitated the establishment of the
program. By sharing experiences and skills at
clinical sites, Brazilian physicians, nurses, and
psychologists familiar with HIV treatment in
resource poor settings mentor local clinic staff
to provide high-quality ART services. The
Brazil-Mozambique-Columbia University
Collaboration seeks young Brazilian
professionals, especially those with background
and expertise in public health or infectious
diseases, particularly in care and treatment of
persons living with HIV and AIDS (PLWHA). Program
Structure Duration of service in Mozambique is
2 months. Some participants have extended their
service period due to their motivation and their
wish to build a high quality service for PLWHA. A
variety of provider types are sought including
physicians, nurses, social workers, and
logisticians, among others. Orientation Upon
their arrival in Mozambique, the fellows are
offered a series of lectures on the epidemiology
of HIV/AIDS, tuberculosis, and malaria in
Mozambique. They are informed of the health care
structure in Mozambique and Ministry of Health
clinical guidelines and patient flow
recommendations. Ongoing, regular meetings are
conducted on a biweekly basis to discuss
challenges faced and to involve fellows in
problem-solving. Fellows are assigned to provide
assistance at a specific clinical site where they
receive day-to-day supervision and guidance from
ICAP/Columbia University clinical and other
technical advisors. Currently, the program has
expanded to four sites in Maputo. ICAP/Columbia
University offers air travel, lodging, a stipend
for food and general expenses during the
fellowship period. Achievements Since its
beginning in February 2005, the Collaboration has
brought 26 young health professionals from Brazil
to Mozambique, including physicians, nurses,
psychologists and social workers.


LESSONS LEARNED
  • Teams of fellows provide clinical expertise,
    innovations in patient flow and improved site
    management.
  • The multidisciplinary HIV model of care
    encourages exchange and nurtures the development
    of site teams.
  • The opportunity for sharing experiences with
    professionals from another country has motivated
    local staff in striving for higher quality when
    delivering care for PLWHA.
  • The Collaboration has stimulated the interest of
    young Brazilian professionals in serving in
    resource-limited countries. Since the
    establishment of the Collaboration, two fellows
    have decided to extend the duration of their work
    in Mozambique for a longer period than initially
    planned.
  • Fellows have maintained contact on their return
    to Brazil and have established a list serve to
    maintain their links with ICAP in Mozambique and
    with their colleagues.

Brazilian doctor (Flávia Porto - left side) and
a Mozambican nurse, Silvina Dumangane Military
Hospital, Maputo
RECOMMENDATIONS
  • To expand Collaboration in order to support
    other clinical sites.
  • To strengthen and expand the partnership with
    Brazilian universities.
  • To expand the participation of other health
    professionals types in the Collaboration, e.g.
    pharmacists.
  • Broaden the Collaboration with other teaching
    institutions and organizations.

Brazilian doctor consults with ICAP ME Advisor,
while Mozambican nurse attends patients at
Military Day Hospital Maputo
Acknowledgements ICAP in Mozambique is supported
by the Presidents Emergency Plan for AIDS Relief
We acknowledge the support of the Mozambique
Ministry of Health, CDC, program participants and
Day Hospital staff
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