Our Global Strategic Information (GSI) group strives to build long-term capacity to support data-driven decision making for HIV/AIDS care and treatment in the country. Through strengthening the presence and quality of strategic information in Mozambique, our goal is to enhance data use at the national level down to the health facility level, contributing to a sustainable reduction in HIV transmission. GSI’s partners in Mozambique include the Mozambican Ministry of Health (MISAU), the Mozambican National Health Institute (INS), Centers for Disease Control-Mozambique, Health Alliance International (HAI), and the University of California, Los Angeles. GSI has been working in Mozambique for more than a decade and works out of the Global Programs for Research and Training office in Maputo.
Integrated Biological and Behavioral Surveillance (IBBS) Surveys
Our Global Strategic Information group provides technical assistance to MISAU in the design and implementation of integrated bio-behavioral surveillance (IBBS) surveys. To date, GSI has supported one round of IBBS surveys among men who have sex with men, two rounds among female sex workers, one round among mine workers working in South African mines, one round among long-distance truck drivers, and one round among people who inject drugs in Mozambique.
Key Populations Mapping
GSI supports work to develop a better understanding of the size and characteristics of key population networks in order to inform HIV prevention and care interventions. Little information is currently known about the size, distribution, and characteristics of PWID, FSW, and MSM populations in areas where the IBBS did not take place.
Antenatal Care Sentinel Surveillance among Pregnant Women
GSI provides technical assistance to MISAU in data analysis and report writing for ongoing HIV surveillance among pregnant women attending public antenatal care (ANC) clinics across Mozambique, known as ANC Sentinel Surveillance. This includes quality assurance of ANC sentinel surveillance data in relation to the regular Prevention of Mother-to-Child Transmission (PMTCT) Program. The results from ANC Sentinel Surveillance provide information for the development of important HIV estimates, such as population HIV prevalence, persons living with HIV, persons in need of ART, and AIDS-related mortality, and will help inform intervention design and resource allocation.PMTCT) Program. The results from ANC Sentinel Surveillance provide information for the development of important HIV estimates, such as population HIV prevalence, persons living with HIV, persons in need of ART, and AIDS-related mortality, and will help inform intervention design and resource allocation.
Research & Evaluation
GSI previously provided technical assistance to CDC-Mozambique and MISAU and worked with Eduardo Mondlane University to implement an electronic patient monitoring system evaluation to assist the PEPFAR Clinical Care and Treatment Team and the Ministry of Health to better understand the information collected at all USG and non-USG care and treatment partner clinics. The evaluation described and compared the functionalities of various systems used as follows: human resources requirements currently needed to implement each patient monitoring system; usefulness of the system; training requirements for staff; hardware/software requirements; flexibility of the system; stability and sustainability of the system; and cost for implementation and ongoing maintenance.
Training and Education
Capacity Building in Surveillance
GSI strengthens technical capacity of Mozambican nationals at MISAU and the the Mozambican National Health Institute in the field of surveillance, including:
- Development and/or updating of surveillance protocols, field tools, operations manuals, and standard operating procedures for field staff conducting trainings in enhanced surveillance techniques and data analysis skills
- Field work and laboratory oversight
- Supporting data management and analysis
- Facilitating writing workshops for reports and manuscripts, and lectures
GSI also leads trainings in basic biostatistics and epidemiology.
PMTCT Cohort Analysis
To build capacity for cohort analysis at subnational and site levels in a sustainable way in Mozambique, GSI develops mechanisms to implement and monitor routine cohort analysis using mixed methods of training of trainers (TOTs) and distance learning. This includes routine cohort analysis in both electronic medical records (EMR) and non-EMR sites. This technical assistance focuses on data abstraction, data management and cleaning, analysis, reporting, dissemination, and use.
Health Informatics & Technology
Data Management Unit and National Health Observatory
GSI provides ongoing technical assistance to the expansion of the Data Management Unit (DMU) at INS. GSI worked to build the foundation of the DMU to store, develop applications to manage, and house surveillance datasets coming from INS. GSI has seconded staff at INS in order to design, develop, and link databases, conduct data modeling, manage large databases and data warehouses, and to build automated on-line reports/dashboards. GSI also supports data ownership and stewardship by facilitating the transfer of MozART data from CDC HQ, to CDC-Mozambique, and to INS. GSI capitalizes on the existing infrastructure and gathers data from other units within MISAU, such as the HIV Program and Public Health Directorate, to support the development and functionality of the National Health Observatory (ONS).
Development of Routine Monitoring System for Option B+ Monitoring and Elimination of Mother to Child Transmission (eMTCT) of HIV
To support the monitoring of the Option B+ program, GSI provides technical assistance to develop and implement an SMS-based monitoring system housed at INS, similar to one developed in Uganda. We will develop a dashboard that will present pre-analyzed summaries and detailed reports for various levels in the health system (i.e. facility, district, provincial, and national). Through the dashboard, critical indicators on implementation will be visible, such as:
- The number of ANC1 visits
- The proportion of women tested for HIV
- The proportion testing positive
- The proportion of women initiated on ART during their first ANC visit
These indicators will make it easier to determine when adjustments to the national PMTCT program are necessary.PMTCT program are necessary.
PMTCT Site Supervision Tools using Tablets
GSI provides health informatics support to the national HIV program in the development and rollout of a standardized tablet-based supervision tool that focuses on ANC visits, early infant diagnosis (EID), family planning, and counseling and testing in the maternity ward. This is a priority of the national PMTCT program to address data quality issues. The data will be included in a PMTCT dashboard that includes data from other programs at PMTCT program to address data quality issues. The data will be included in a PMTCT dashboard that includes data from other programs at MISAU to give a more complete picture of the PMTCT program down to the facility level.PMTCT program down to the facility level.
Tuberculosis Prevalence Survey Data Management Solution
In support of the first-ever survey to estimate tuberculosis prevalence, GSI leads the development of a comprehensive, digital, open-source data management solution, which supports the full scope of field data collection, data quality activities, central field-progress monitoring, central laboratory-sample tracking, and project management.
Program Monitoring and Quality Improvement
Continuous Quality Improvement
GSI is creating a unified database with a dashboard for storage, analysis, and visualization of continuous quality improvement (CQI) data on the quality indicators, the root causes and the action items, at different levels (facility, district, provincial, and national) across time and facility visits to evaluate trends in service delivery quality. CQI, in the context of HIV, attempts to improve service delivery for HIV programs by gathering data to measure the quality of services through internal clinical staff and external evaluators through ongoing site visits and development of action plans. About 175 sites are expected to eventually carry out CQI activities across Mozambique.