In Zambézia Province, Mozambique, where the prevalence of HIV and Tuberculosis (TB) co-infection remains high, integrating HIV and TB services is a public health priority. In 2018, 36% of those screened TB-positive were also HIV-positive, according to the World Health Organization.
The Avante program supports health facilities (HF) to provide high quality HIV/TB clinical care services. This program is funded by PEPFAR through the United States Centers for Disease Control and Prevention (CDC) and seeks to control the HIV epidemic by supporting the sustainable implementation of HIV and Tuberculosis (TB) services in the province of Zambézia. The Avante program is implemented by Vanderbilt University Medical Center (VUMC) and its affiliate Friends in Global Health (FGH), working in partnership with the Government of Mozambique (GoM) at the national, provincial, district, health facility and community levels. FGH has been working in Zambézia Province since 2006.
Support provided at the Health Facility and community level
- Human Resources:
• District TB Officers and Cough Officers assigned to supported districts
• Counselors allocated to TB clinics
- Clinical mentoring and TB cascade training
- Collect and review of TB data at supported health facilities, with discussion of results with service providers to identify bottlenecks in program implementation
- Report on TB preventive treatment using databases (OpenMRS) with the support of data clerks for evidence-based solutions
- Transport laboratory TB specimens throughout the province and support logistical initiatives
- Expand TB One Stop Model and improve infection control
- Reproduction of TB log books, records and Information, Education and Communication (IEC) materials
- Provision of hospital furniture, equipment and improved infrastructure
- Support counselors at Penitentiary Health Facility in Quelimane for TB and HIV screening of prisoners
Support provided at provincial level
- Quarterly meetings for TB cascade analysis
- Provision of technical assistance to:
• TB focal point in the implementation of TB National Guidelines
• TB-Multidrug Resistant Provincial committee
- Provision of technical and logistical support for joint supervision visits with Provincial Health Authorities
Support provided at national level
- Participation in Ministry of Health technical workgroups on a rolling basis
During the July through September 2020 period, 4,773 TB patients were registered (the highest reported number of TB cases in a quarter since the beginning of the implementation of Avante) with 100% coverage in HIV testing. Overall, 22% of TB patients (1,041) were TB/HIV co-infected. From the total 1,041 TB/HIV co-infected patients, 949 were previous on ART, 87 initiated ART, and 5 co-infected patients were in the process of initiating ART. In addition, 99.8% of co-infected TB / HIV patients (1,039) had started cotrimoxazole prophylaxis.