ACTIVITY DESCRIPTION This activity also relates to activities in Counseling & Testing (#6673), TB/HIV (#) and In COP 07, In COP 07, Africare's Technical Response to AIDS-Affected Populations (TRAP) project will continue care and support services which commenced in COP05 in two states, Lagos and Rivers. Facility based care will be expanded in COP07 to include home based care services. With funding from USG, the Africare TRAP project is currently supporting basic care services in 7 health facilities and 1 stand alone site. The health facilities are: University of Port Harcourt Teaching Hospital; Braithwaite Memorial Hospital; Niger Hospital; Rivers state University of Science & Technology (Youth Friendly Center); Community Health Center, B-Dere; and Nigerian Air force Medical Center in Rivers state and Shomolu General Hospital in Lagos state. The stand alone site is at Mile 3 Motor Park, Rivers state. The project will set up services in 4 additional health facilities with a focus on sites were TB testing and/or treatment services are provided. This will bring the number of health facilities supported by the project to 11. HIV+ clients will be screened and referred for TB diagnosis and/or treatment. The project will also set up stand alone sites at Mile 1 Motor Park in Rivers state, Yaba market and Yaba Motor Park in Lagos state. Services will also be carried out at identified primary health facilities in project communities with the support of volunteer health workers. Community interventions will further be strengthened and home based nursing care services will be provided by Africare in partnership with 5 CBOs and NGOs (Rhema Care Partners, Lazarus Care Mission International, Initiative for African Youth Development, Daughters of Charity and Society for Women and AIDS in Africa, Nigeria). C&S services will be offered to ensure that 20% effort is Lab (CD4 counts, hematology, chemistry), 30% is OI management with prophylaxis and 50% is Home Based Care (HBC). Using USG/GON PC guidance 5,500 PLWHA will be provided with PC services. The C&S services in COP07 will include: basic nursing care; assessment of signs and symptoms including pain; pain care medications like paracetamol; nutritional assessment; adherence counseling; prevention for positives; facilitating support groups; bereavement services; depression assessment; spiritual counseling with social supports (transportation, communication and referrals); provision of Care Kits - ORS, ITN, water guard, bleach, cotton wool, gloves, soap, calamine lotion, vaseline, GV; and patient training and education in self-care. With the integration of TB-HIV program activities into the C&T activities in hospitals where C&S is provided, HIV+ clients will be screened and referred for TB diagnosis and/or treatment. IEC materials will be produced in local languages on basic infection controls. The home based care providers will work with care givers of PLWHA and will be assigned or linked to a team of medical staff in the hospitals that report to the team's physician. The project will also work with community groups and members, with the full involvement of PLWHA to form or join existing support groups. PLWHA identified through community mobilization and VCT will be referred to the 5 partner organizations (FBO/NGO) for psychosocial, basic clinical follow up and HBC. Referral for advanced laboratory diagnostics and clinical management will be made to USG or GoN supported facilities. The services in the partner organizations will be provided by trained counselors, nurses, and PLWHA support group members. The project's volunteer home based care providers will be assigned to follow up for HBC services. USG/GoN PC and HBC curricula will be adapted to train 150 volunteers, HBC workers and health care workers. In addition, trainings on nutrition and economic empowerment activities will be provided to PLWHA. The capacity of mobile counselors will be built to do symptomatic screening for TB and other OIs in homes and make referrals for advanced management. The capacity building of health care providers will ensure continuity and spill over beyond Africare catchment areas and project close out. Africare will adapt USG developed data tools to track activities and follow up patients at project sites. SOPs and providers' manuals will be given to all service providers to ensure quality service delivery.

CONTRIBUTIONS TO OVERALL PROGRAM AREA Africare's C&S component will contribute to PEPFAR C&S overall goal of mitigating the impact of HIV on 1,750,000 individuals infected and affected by HIV and AIDS through compassionate care of 5,500 PLWHA. This activity will also contribute to the sustainability of the program through capacity building of 5 partner institutions and 150 health care providers and promoting community involvement. Eleven service outlets will be targeted for provision of HIV related palliative care services. The integrated approach will encourage increased use of C&T services by ensuring that clients who test HIV+ receive necessary care. Likewise, TB diagnosis/treatment of TB co-infected PLWHA in collaboration with NTBLCP will create the opportunity for receiving timely diagnosis for TB and proper treatment of OIs. The outreach program will ensure that care services reach underserved communities for linkages and referrals in particular in the Delta region. The networks and linkages

established with NGO/FBOs, state and local authorities will ensure the continuum of care in the communities.

LINKS TO OTHER ACTIVITIES Africare Palliative Care activity is related to Counseling and Testing (HVCT # 3.3.09) as the entry point to care and support, as well as TB/HIV (#3.3.07). All served HIV+ clients needing advanced care will be referred to USG supported, GON and Private ART sites. Clients will also be referred to Africare's TB-HIV program and prevention activities of other programs. The networks and linkages established with NGO/FBOs, state and local authorities will ensure the continuum of care in the communities. It will avail PLWHA a complete package from the point of testing through to treatment and between the project sites/health facilities to their homes. Networks will be formed among USG/GON supported facilities, NGO/FBO and other community groups to mobilize support in the area of capacity building and referrals for treatment.

POPULATIONS BEING TARGETED Africare's C&S activities will target PLWHA and their families, volunteers, care givers, and health care providers along with policy makers at the local and state government levels.

ACTIVITY DESCRIPTION Africare's TB-HIV program is also related to Basic Care and Support (6672), Counseling and Testing (6673) Africare is currently supporting 4 sites in 2 states: Somolu General Hospital in Lagos state, and Niger Hospital, Braithwaite Memorial Hospital and University of Port Harcourt Teaching Hospital in Rivers state to carryout HCT with care & support (C&S) services. Mobile HCT is also carried out in selected motor parks. In COP07, activities will be expanded to include TB-HIV program, in collaboration with the National TB and Leprosy Control Program (NTBLCP). Under this new programmatic activity Africare will hire a TB-HIV project officer to provide leadership in this activity. In COP07, Africare will provide HIV related palliative care to 5,500 persons. It is estimated that approximately 400 HIV+ clients attending HIV palliative care services will receive treatment for TB disease. The TB-HIV program will be integrated into the HCT program; that is, clients for TB diagnosis will be referred for HIV testing and vice-versa. The project will provide HCT to 1,000 TB patients and TB screening to 3,000 HIV+ clients. GON has setup TB DOTS centers in project sites. The project will procure necessary laboratory equipment such as microscopes, chambers for sputum smear preparations, etc., and training of staff. NTBLCP will ensure that drugs and reagents are made available at the sites. Mobile clinics at the motor parks and other public places will target MARPs such as truck drivers, mobile populations, etc. The project will work with Primary Health Centers, which will serve as Outreach Point of Service (OPS) Centers where clinic days will be used for HCT as well as TB screening and referrals made for laboratory diagnosis. TB clients with HIV will be linked to the project's C&S services which include clinical and laboratory diagnosis, home based care, and psychosocial and spiritual support. Clients that are due for HIV treatment will be referred to ART sites in the network. At the health facility and community levels, infection control education will be emphasized. The project will use IEC materials, health workers, volunteers, care givers and peer educators to educate beneficiaries on basic TB infection control such as basic hygiene, ventilation, and drug adherence. Africare will train Africare staff and health care providers within the health facilities, who will in turn train mobile counselors and volunteers using an approved national training curriculum. A total of 40 care providers will be trained and educated to screen for TB among HIV+ clients. With the use of updated data tools, Africare's M&E staff will track activities at project sites. Africare will build the capacity of health care providers, CBOs/FBOs and NGOs to ensure sustainability after the project close out. All providers will be provided with manuals/SOPs adapted from existing national guidelines to assist them in service provision. CONTRIBUTIONS TO OVERALL PROGRAM AREA: Africare's TB-HIV program in Lagos and Rivers states will build the capacity of the health facilities on TB-HIV management. The integration of TB diagnosis into the HCT services will afford HIV+ clients the chance of knowing their TB status early. Conversely, increased availability of diagnostic counseling and testing services in medical settings will assist to identify the number of clients with TB-HIV who are potential candidates for HIV treatment and care services. The TB treatment program by NTBLCP will strengthen the project's palliative care program. Training of mobile counselors and volunteers on screening for TB would assist early diagnosis of TB. The outreach programs will also ensure that services reach the underserved in the communities. The networks and linkages established with CBOs/FBOs, state and local authorities will close gaps in the provision of services to the communities. This will help reduce new infections. This activity will also contribute to the national plan of early diagnosis of TB-HIV and referral/linkages to care due.

LINKS TO OTHER ACTIVITIES Africare's TB-HIV program is also related to Basic Care and Support (6672), Counseling and Testing (6673). TB patients that are HIV+ will be counseled on prevention for positives messaging while those that are HIV- will be given prevention messages as well. The project will ensure that clients for TB diagnosis are referred for HIV C&T and those that are HIV+ enroll in the project's care and support program. The home based care program for clients will provide basic care kits, prophylaxis for minor ailments, spiritual counseling and other supports. Clients will also be referred to ART sites for treatment. The HVTB program will assist in strengthening the capacity and practices in health facilities to screen, diagnose and treat HIV-infected patients for TB which is an essential component of quality care in HIV programs.

POPULATIONS BEING TARGETED: The HVTB activities target specifically HIV+ clients and those that may be at risk of infection such as their family members. Activities will target young people, adults, pregnant women, truck drivers/mobile populations and other most at risk populations. Project activity will test for TB among and provide information and

other services to care givers and family members of PLWHA on TB case management. Medical staff in the health facilities and volunteers from partner organizations would be trained on TB management especially among PLWHA. Similar training will also be made available to the support groups, local groups and care givers of PLWHA in project communities.

KEY LEGISLATIVE ISSUES ADDRESSED Africare's TB-HIV program will help increase gender equity in programming by ensuring that equitable number of men and women participate in program activities. Stigma and discrimination of PLWHA is high in project communities leading to problems of disclosure by those infected, either to partners or family members. Activities will support programs targeted at reducing stigma and discrimination in the project communities, which will encourage care and support for PLWHA. Activities will use strategies that address other social norms of women's and men's behavior in the communities that increase their vulnerability to impact of HIV and TB. Such strategies include the involvement of men as peer educators, counselors, support group members, etc.

EMPHASIS AREAS: Activity's major emphasis will be on training of project staff, health workers, volunteers, CBOs/FBOs, other partners and care givers on TB-HIV management and caring for people with TB-HIV. Minor emphasis will be on developing policy and guidelines, human resources, development of networks/linkages/referral systems, commodity procurement, logistics and infrastructure. Funding will be expanded to the area of community mobilization and advocacy for care and support of those living with TB-HIV. Networks will be established with government agencies, NGOs, CBOs/FBOs and other groups for support in program implementation.

ACTIVITY DESCRIPTION: In COP07, Africare will provide HIV C&T services at 8 service outlets (5 in COP 06 plus additional 3 in COP 07) in 2 states. Activities will be expanded to include TB diagnosis and treatment in collaboration with NTBLCP; clients for TB diagnosis will be referred for HIV counseling and testing and vice-versa. With support from USG, Africare is currently supporting 4 health facilities in 2 states to provide HIV C&T at Somolu General Hospital in Lagos, and Niger Hospital, Braithwaite Memorial Hospital and University of Port Harcourt Teaching Hospital in Rivers state. Mobile C&T services are also carried out using volunteers at selected motor parks. In COP07, project activities will be conducted in a total of 8 sites (the current stationary and mobile sites plus 3 new sites). Africare will provide HCT and give results to 26,000 including 1000 TB patients receiving counseling and testing for HIV and their test results. To achieve these targets, 3 additional sites, all primary health care centers will serve as Outreach Points of Service (OPS) centers. Project will use provider initiated model for C&T services in the hospitals. AfriCare will partner with community based organizations to carry out community CT activities and will encourage (through mobilization and advocacy) couples counseling and testing. In addition, the activities will promote disclosure to partners and family members. One hundred health care providers, counselors and volunteers will be trained to provide HCT services to clients at facilities and within the community, using a national training curriculum. These groups will also be trained to screen for signs and symptoms of TB and other OIs and make referrals for laboratory diagnosis. There will be refresher trainings for previously trained counselors on updated national guidelines on C&T. The project will produce BCC/IEC material and provide SOPs as reference materials for the trained HCT providers. The capacity building of health workers, CBOs, NGOs and volunteers, will ensure sustainability after the project close out. HIV testing will be carried out using a GON approved testing algorithm. An ongoing QA program, which will consist of quarterly proficiency testing and blinded rechecking, will be carried out. Test kits will be procured using the Supply Chain Management System. Test kits and other logistics will be stored centrally by Africare's Country Office in Abuja and distributed to the sites based on projected needs with proper LMIS and inventory management by designated staff. Clients that test HIV+ will be referred to the project's care and support program and those that need treatment will be referred to USG/GON supported sites in the network. Individuals that are HIV negative will be linked to prevention programs. Condom education and distribution will be carried out at the hospitals and during mobile clinics. Condoms will be sourced from Society for Family Health for mobile HCT activities. Africare's M&E staff will track activities at project sites.

CONTRIBUTIONS TO OVERALL PROGRAM AREA Africare's HCT program is expected to help increase the number of people accessing HIV testing services. Increased availability of diagnostic counseling and testing services at health facilities plus the communities will assist in identifying the number of clients with infection who are potential candidates for treatment and palliative care services. HCT activities targeting pregnant women at outpatient departments, primary health care centers and antenatal clinics will contribute to other activities such as the PMTCT program. The project will refer clients for further comprehensive PMTCT services at already identified sites. The outreach program will also ensure that services reach underserved male clients in hard to reach communities with referrals for further tests or treatment, care and support. The networks and linkages established with CBOs/FBOs, state and local health facilities will close existing gaps in provision of services to the communities. The referrals for treatment will help feed into the treatment program provided by PEPFAR, GON and other agencies. AfriCare will build the capacity of partner FBOs/CBOs on program management to ensure sustainability.

LINKS TO OTHER ACTIVITIES Africare's HCT program is related to HIV treatment services (3.3.11), condom & other prevention (3.3.05), Basic Care & support (3.3.06), TB-HIV (3.3.07) and PMTCT (3.3.01) programs. The HIV C&T will strengthen the HIV prevention and palliative care programs in the states and improve utilization of AfriCare's and/or other USG supported care and treatment services in these states. Clients that are HIV negative will be referred for HIV prevention programming for sustained responsible HIV prevention behavior. Those that are HIV+ or have TB-HIV will also be referred to the project's care services. Clients identified at the antenatal clinics will be referred to PMTCT programs within project sites. Activities will also target discordant couples with counseling on prevention.

POPULATIONS BEING TARGETED Africare's HCT activities are targeting MARPS (including

truck drivers, mobile populations, in and out-of-school youths), couples, and PLWHA family members. Project activities will make counseling and testing available to the care givers and family members of PLWHA. Trainings on HIV programming will be made available to medical staff, community groups and other relevant organizations.

KEY LEGISLATIVE ISSUES ADDRESSED Project activity will help increase gender equity in programming through HIV counseling and testing targeting adults especially women of child bearing age, men, young persons, children and other vulnerable groups. Community project activities will encourage more male participation to enable them access HIV testing for early diagnosis. This will be done through the use of culturally adapted BCC materials, vigorous campaigns and mobilization to educate people on the benefits of early diagnosis and treatment. Stigma and discrimination of PLWHA is also high in project areas. Activities will support mobilization and palliative care programs targeted at reducing stigma and discrimination in project communities and encourage care and support of PLWHA.

EMPHASIS AREAS Africare's HCT activities' major emphasis will be on community mobilization and participation along with building networks/linkages/referral systems. Minor emphasis will be on training, Human Resources, quality assurance/supportive supervision, logistics, commodity procurement and infrastructure. Networks will be formed with government agencies, NGOs, and other groups for support in mobilization activities to generate clients for HIV test. Staff of health facilities and volunteers of partner organizations will be trained to conduct quality counseling and testing. Africare staff along with partners will carry out quality assurance in project sites and provide supervision. Test kits and other logistics will be Africare's management responsibility.