ACTIVITY DESCRIPTION This activity also relates to activities in counseling & testing (#6681), Care & support (#6675), ARV Services (#6678), OVC (# 6679) and laboratory infrastructure (#6680). AIDSRelief will increase the PMTCT sites it supports from 12 in COP06 to 30 in COP07 in 15 states, provide counseling and testing to 21,000 pregnant women, and provide Antiretroviral (ARV) prophylaxis to 1,300 clients. This activity will include, as a part of the standard package of care, provider initiated Opt-Out HIV Counseling and Testing (C&T) routinely done at antenatal clinics (ANC), labor and delivery (L&D) and/or immediate post-delivery. Same day results will be provided to clients. We will use group and individual pre- and post-test counseling strategies and rapid testing for women of unknown status in labor. Partner testing will offered as part of counseling through referral to on-site VCT centers. Peer counselors and community based health workers will assist in tracking these partners. In addition, free hematinics will be provided to all PMTCT clients. Clients will have access to free laboratory services including CD4 measurement. Those requiring HAART for their own health care will be linked to a within network ARV center. Strong referral systems that incorporate active follow up will be put in place to ensure that women are not lost during referral for ARV services. For the anticipated number of women not requiring HAART, the current WHO recommended short course ARV option will be provided. This includes ZDV from 28 weeks, intra-partum NVP, and a 4 day ZDV/3TC post-partum "tail". Infant prophylaxis will consist of single dose NVP with ZDV for 6 weeks. All HIV+ women will be linked post-partum to a HIV/ARV point of service, which will utilize a family centered care model whenever feasible. HIV+ women will be counseled pre and postnatally regarding exclusive breast feeding with early weaning or exclusive BMS using the WHO UNICEF curriculum adapted for Nigeria. We will provide training to 180 (Local partner treatment facility) LPTF staff on PMTCT and infant feeding options using GoN curriculum with emphasis on improving counseling skills. LPTFs will be encouraged to use non-medical staff in counseling and testing including people living with HIV and AIDS (PLWHAs) to act as peer counselors. Training of TBAs using an adapted curriculum will be conducted. We will have a focal senior PMTCT specialist to offer technical assistance to our LPTFs and take a lead on training and supervisory activities. AIDSRelief will provide indirect technical support to 41 facilities at secondary and primary levels in 11 states to benefit an estimated 24,600 women. This will be done through the sharing of our counseling and testing support tools, assisting in implementing the GoN national PMTCT monitoring systems, providing zonal/regional joint trainings on PMTCT and joint periodic site visits for support supervision. We will train at least 2 health workers at each of the 41 facilities in the provision of quality PMTCT services and through them indirectly target 24,600 HIV+ pregnant women to receive ARV prophylaxis. AIDSRelief will have a total of 12 PMTCT sites by end of COP06 spread across 6 states of Benue, Edo, FCT, Kaduna, Kano and Plateau and will add 16 new sites in COP07 in 9 new states of Anambra, Kogi, Nasarrawa, Ondo, Rivers, Taraba, Adamawa, Enugu, and Ebonyi bringing the total of PMTCT sites receiving direct support to 30 in 15 states. AIDS Relief will collaborate with UNICEF-supported PMTCT sites in its scale up plans. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will provide counseling and testing services to 21,000 pregnant women, and provide ARV prophylaxis to 1,300 mother and infants pairs. This will contribute to the PEPFAR country specific goals of preventing 1,145,545 new HIV infections in Nigeria by 2009. With 30 operational sites in 15 states, the PMTCT activity is in line with the desire of the GoN to have 1,200 PMTCT sites operational by 2008 and the USG's target of having 80% PMTCT coverage for antenatal clinics across the country. By targeting an additional 41 facilities through indirect support, the activity will further contribute to the scale up of PMTCT services in Nigeria. LINKS TO OTHER ACTIVITIES The PMTCT services will be linked to HVCT (6681), HBHC (6675), HTXS (6678), HTXD (6682), HKID (6679), HVTB (6677), HLAB (6680) and HVSI (6674). Pregnant women who present for C&T services will be provided with information about the PMTCT program and referred accordingly. ARV treatment services for infants and mothers will be provided through ART Services. Basic pediatric care supports, including TB care, are provided for infants and children through our OVC activities. PMTCT activities will focus on strengthening community and home-based care services to pregnant women where appropriate in collaboration with the 7-Diocese program, other family centered care services provided by UNICEF and GoN and the Catholic secretariat of Nigeria (CSN). AIDS Relief will collaborate with other implementing partners and in particular IHV-ACTION working at tertiary institutions within our area of coverage for infant diagnosis using dried blood spot (DBS) technology. Our senior PMTCT specialist will offer technical assistance to 7-Diocese facilities that will eventually be taken over by us to become comprehensive sites. A PMTCT referral coordinator in each state will coordinate all the linkages. POPULATIONS BEING

TARGETED This activity targets women of reproductive age, infants and PLWHAs. It will specifically target 21,000 women attending ANC for counseling, testing and receiving results and 1,300 for ARV prophylaxis including 1,300 infants who will also benefit from immunization services. The activity will indirectly target 41 GoN and other FBO sites in 11 states by training 82 PMTCT providers. These will include 22 state facilities and 19 faith based organizations that offer PMTCT services. In this way we will indirectly benefit an estimated 24,600 pregnant women estimated to be receiving CT and an estimated 2,460 HIV+ women and their infants receiving ARV prophylaxis. KEY LEGISLATIVE ISSUES ADDRESSED Integrating PMTCT with ANC and other family centered services will ensure gender equity in access to HIV and AIDS services and in particular that of women and children. By providing counseling on infant feeding options and immunization, there will be a reduction in infant mortality rates. EMPHASIS AREAS This activity has major emphasis on human resources and minor emphasis on commodity procurement, quality assurance, quality improvement and supportive supervision, training, and development of networks/linkages/referral systems.

This activity was suspended at the direction of the OGAC Prevention TWG.

ACTIVITY DESCRIPTION This activity also relates to activities in Counselling and Testing 6681, Medical Transmission Injection Safety (3.3.04), and, and Laboratory Infrastructure 6680.

This activity will support capacity development for Blood safety (training and equipments), screening for HIV, universal precautions and good laboratory practice, waste management and quality assurance/quality control (QA/QC) for HIV serologic testing.

The first component of this activity is capacity development for Blood safety and this will entail personnel and institutional capacity development aimed at improving quality of blood safety services at site levels. Personnel capacity development will involve trainings of 168 Local Partner Treatment Facility (LPTF) personnel in universal precaution, good laboratory practice, Laboratory safety and use of rapid HIV test kits. The Institutional capacity development component will only cover the provision of basic needs for the collection of blood and HIV serologic testing to ensure that all blood meant for transfusion is HIV-Free.

In line with the Government of Nigeria (GoN) National training guideline, and curriculum for HIV testing for blood transfusion safety, AIDSRelief will conduct an AIDSRelief -wide central TOT for 2 Senior Laboratorians per site. These two senior laboratorians will in turn train all the Laboratory Officers in their sites, including all Laboratory staff that handle blood for transfusion. The site trainings will be conducted under the supervision of the AIDSRelief Focal Persons for blood safety.

This activity will promote the principles of Universal Safety Precautions, the reduction of unnecessary transfusions, exposure to blood, accidental injury/ contamination as well as the provision of essential consumables and services that protect the health worker from contacting infections especially HIV. These Universal precaution materials include personal protective equipment such as hand gloves and laboratory coats; and other consumables (Methylated-spirit, hypochlorite solutions,antibacterial soaps, etc), which will be provided for the sites. Other equipment to be provided will include centrifuge, thermometer, pipettes and Determine test kits. In addition, each site will make provisions for referral of Staff for access to Post Exposure Prophylaxis (PEP) in case the need arises.

Screening for HIV will follow the national testing algorithm to test for every unit of blood screened. Expectedly, a total number of 10,400 units of blood will be screened in COP 07. All screening services will be linked to pre and post test counseling services at each site.

Proper waste management will be encouraged through the use of Bio-Hazard Bags, suitable sharps containers and the use of incinerators. In order to maintain high quality laboratory results, AIDSRelief will institute an aggressive QA/QC program that involves on-site quarterly monitoring and retraining; and proficiency in rapid HIV testing.

This activity will provide support for 26 Service outlets (LPTFs), train 168 individuals in counseling and testing, blood safety protocol, and provide HIV screening for an estimated 10,400 blood units.

CONTRIBUTION TO OVERALL PROGRAM AREA This activity contributes to the USG target of preventing 1,145,545 new infections by 2009 through prevention of medical transmission of HIV by ensuring the supply of safe and screened blood for blood transfusions. This activity will help establish mechanisms for referral to tertiary centers for blood banking services, while providing the logistics and training to primary and secondary health facilities to establish high quality blood screening practices. It also contributes to the overall goal of the Safe Blood Foundation for Africa of reducing transmission of HIV through blood transfusion and saving lives through the provision of safe blood.

LINKS TO OTHER ACTIVITIES AIDSRelief activities in blood safety relate to activities in Counseling and Testing (6681) because referrals will be made to C&T services where appropriate, Medical Transmission Injection Safety (3.3.04) for universal precaution equipment, and, and Laboratory

Infrastructure 6680.

This activity is most immediately linked to HLAB (3.3.12) to strengthen the testing conducted on all blood samples at our LPTFs. We will strengthen the link with other LPTF health services to ensure that these activities benefit from a screened, safe blood supply and for program sustainability.

We will collaborate with Safe Blood for Africa Foundation for the provision of specialized training on blood safety for our LPTF personnel. We will coordinate with Medical management and medical injection safety (MMIS) for the provision of medical waste handling equipment and training, collection, transportation and burial of sharps and other medical waste.

POPULATIONS BEING TARGETED This activity targets health care providers to include mainly laboratory staff including laboratory assistants. This activity will also target doctors and nurses. AIDSRelief mainly work with faith-based rural facilities that serve rural populations who would otherwise have limited or no access to these services.

We will indirectly target 11 other facilities both state and faith-based within the 11 states and include 22 health care workers from there in our training activities for safe blood procedures and through ensure that an estimated 10,400 blood units are screened before transfusion.

KEY LEGISLATIVE ISSUES ADDRESSED None

EMPHASIS AREAS This activity has a major emphasis on training and minor emphasis on logistics, commodity procurement, quality assurance, quality improvement and supportive supervision and linkages with other sectors and initiatives.

ACTIVITY DESCRIPTION AIDSRelief (AR) local partner treatment facilities (LPTFs) consist largely of primary health care institutions located within communities that are poor and underserved in all areas of social infrastructure including health care. A proportion of HIV infections are still transmitted within these health care facilities through unsafe injection practices.

This activity encompasses the training of a total 630 individuals in various cadres and categories of health care workers present in different parts of our LPTFs including clinics, wards, blood banks, labs, theatres, and maintenance on universal precautions and medical waste management. This will include the training and retraining of nurses, doctors, laboratory staff, hospital cleaners, laundry workers and waste managers on proper techniques for drawing blood, dispensing blood into laboratory bottles for laboratory assessment, and disposal of used needles, sharps and other materials contaminated by blood and other potentially infectious human materials. We will include training of trainers in the training program and help the health workers trained pass on the information to their colleagues thus ensuring sustainability of this activity.

This activity will involve the provision of sterile needles and syringes, sharps containers and liquid hand washing soap in LPTF wards, clinic rooms, laboratory work stations and strategic areas to encourage their use. The provision of latex gloves for all health workers that potentially handle sharps and the provision of rubber gloves and boots for other ancillary hospital staff that come into contact with sharps and contaminated materials is also part of this strategy. AR will work with each LPTF to improve access to water at each hand washing point. For sustainability purposes, we will ensure that these activities are integrated within the overall hospital injection safety systems.

AIDSRelief will collaborate with Making Medical Injections Safer (MMIS) to supply and distribute single-use needles, safety boxes and boots to all AR LPTFs. AR will work with MMIS to provide supportive supervision and training for AR injection safety personnel who will in turn train personnel in different AR supported facilities. AR will obtain and use MMIS supplied manuals to conduct follow up on site trainings at AR LPTFs. AR will also obtain information, education and communication (IEC) materials from MMIS to be displayed in strategic parts of AR supported facilities. AR will also conduct trainings on behavioral change communication (BCC) to cut down on unnecessary use of injections in LPTFs.

In COP06, AIDSRelief supported specific safe injection activities at 3 LPTFs in 2 states of Kano and Plateau. In COP07, we will support safe injection activities at all of our 26 LPTFs in 11 states of Anambra, Benue, Edo, FCT, Kaduna, Kano, Lagos, Kogi, Nasarrawa, Oyo and Plateau.

CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity contributes to the USG target of preventing 1,145,545 new HIV infections through prevention of medical transmission of HIV. Safe injection activities at AIDSRelief LPTFs will help reduce HIV transmission and prevent new HIV infections in Nigeria. Planned trainings will educate health care workers to be aware of the potential dangers associated with the handling of sharps and materials contaminated with blood or bodily fluids. Providing sterile needles and syringes, as well as improving waste evacuation and disposal infrastructure will reduce the transmission risk and infection rates to patients, health workers and ancillary staff.

LINKS TO OTHER ACTIVITIES AIDSRelief activities in injection safety relate to activities in MTCT (3.3.01); HVTB (3.3.07); HKID (3.3.08); HTXD (3.3.10); HTXS (3.3.11); HLAB (3.3.12) and HBHC (3.3.06) and HMBL (3.3.02) to ensure that health workers under all these areas adhere to principles of MMIS and universal precautions. We will also link this activity to all facility departments to ensure uniform standards in MMIS and universal precautions.

POPULATIONS BEING TARGETED This activity will mainly target health care providers including doctors, laboratory workers, nurses, pharmacists. Ancillary staff, who may not have direct patient contact but do have contact with patient waste materials, will also be targeted. It also targets other workers within the LPTF that do not directly work for the AIDSRelief program by including them in our training activities.

KEY LEGISLATIVE ISSUES ADDRESSED By making injections safe and through IEC/BCC activities there will be a reduction in stigma and discrimination against PLWHAs.

EMPHASIS AREAS This activity has major emphasis on training on universal safety precautions and minor emphasis on Commodity Procurement of needles and safety boxes, Information, Education and Communication as detailed in the activity description in Section 1 above.

ACTIVITY DESCRIPTION: This activity relates to activities in PMTCT (#6683), HKID (#6679), HMBL (#6676), HVTB (#6735), HVCT (#6681), HTXD (#6682), HTXS (#6678), HLAB (#6680) and HVSI (#6674). AIDSRelief (AR) will in COP07 provide a comprehensive package of adult basic care and support to a total of 31,000 people living with HIV and AIDS (PLWHA). This will be done in accordance with the PEPFAR and Government of Nigeria (GoN) national palliative care policy and guidelines. Approximately 30% of the effort will be spent on OI management and prevention. Our package of care will include facility based diagnosis and management of opportunistic infections (OIs), pain management, basic nursing care and nutritional assessment/counseling. We will provide prophylaxis for OIs (Cotrimoxazole) for 31,000 Adult PLWHA. We will ensure that PLWHA under our care have access to community and home based care services through our community and faith based networks (CBOs and FBOs). We will provide psychosocial and spiritual counseling through our networks of FBOs, CBOs and PLWHA. We will provide adherence counseling for those on antiretroviral therapy and/or TB treatment and prevention counseling for HIV infected individuals. Approximately 20% of the effort will be on equipping local partner treatment facilities (LPTFs) to carry out laboratory (CD4 counts, hematology, and chemistry) and radiological diagnosis and monitoring of OIs such as malaria, Pneumocytic jiroveci pneumonia (PCP). PLWHA on non-ART care will receive CD4 testing every 6 months including other lab tests such as chemo analyses and haematoanalyses. Approximately 50% of the effort will be on Home Based Care (HBC). A standardized home based care (HBC) kit will be used to provide individual patients with their essential needs and every PLWHA will be provided with insect treated nets, water guards and a nutritional assessment. Our HBC activities will be done by community based organizations (CBOs) such as 7-Diocese of Catholic Relief Services (CRS) in Benue, Kaduna and Edo states, CSADI in Kano, Spring of Life in Plateau and other CBOs attached to our LPTFs in the 15 states. These FBOs and CBOs will be subgrantees of AR. AR has been strengthening institutional and health worker capacity to provide such services and will continue to do so in COP07 for all the 28 LPTFs and 10 satellite sites. We will train 359 persons including doctors, pharmacists, nurses and counselors to increase the capacity at LPTFs to diagnose and manage common OIs, provide supportive counseling, strengthen laboratory diagnostic facilities and increase pharmacy capacity for stocking and dispensing of OI drugs and other palliative care medications. AR will train community volunteers including PLWHA and religious leaders to help with the psychosocial and spiritual counseling respectively. AR will use (GoN/USG) recommended standardized training aides and manuals for all of community volunteer trainings. Information, education and communication (IEC) materials will be provided to enhance these trainings. As part of the overall AIDSRelief strategy for health systems strengthening and sustainability we will provide training in management for all LPTFs administrators using funds from the HTXS (3.3.11). In COP07, we will provide adult basic care and support services at 28 LPTFs in 15 states of Anambra, Benue, Edo, FCT, Kaduna, Kano, Kogi, Nasarrawa, Ondo, Rivers, Taraba, Adamawa, Enugu, Ebonyi and Plateau. CONTRIBUTIONS TO OVERALL PROGRAM AREA AIDS Relief's expansion of adult basic care and support activities including palliative care to 28 LPTFs and 10 satellite sites and support for effective linkages with HBC providers in the community will contribute to increased access of such services to underserved rural communities. By providing services to 31,000 Adult PLWHA we will contribute to the overall PEPFAR palliative care target of providing these services to 10 million people globally by 2009. The activity contributes to the overall AIDSRelief comprehensive HIV and AIDS services by providing the supportive services for all Adult PLWAs including those on ART. LINKS TO OTHER ACTIVITIES AIDSRelief activities in adult basic care and support are linked to MTCT (#6683 ,HKID (#6679), HMBL (#6676) HVOP (), HVTB (#6735), HVCT (#6681), HTXD (#6682), HTXS (#6678), HLAB (#6680) and HVSI (#6674) to ensure that PLWHA have continuum of services at all of our LPTFs. We will work with other CBOs and FBOs including the 7-D program of CRS for the provision of HBC, palliative care including psychosocial support for our clients. We will work with the Catholic Church and other faith based networks for the provision of psychosocial support for our clients. The CBOs and FBOs will be funded to provide the community and home based services for our clients. We will provide facility based medical care for clients under the care of FBOs and CBO but the OI drugs costs will be met by them. We will work with the GoN/USG in the harmonization of basic palliative care services and in the standardization of training manuals for community volunteers and providers. POPULATIONS BEING TARGETED AIDSRelief mainly targets PLWHA receiving services from FBO that are predominantly located in rural and previously underserved areas. We will target 31,000 PLWHA including PMTCT clients. We will indirectly target 2 state

hospitals and 2 faith based facilities/organizations per state where we are working, a total of 44 facilities. We will support the training of at least 2 health providers and/or community volunteers from each facility or organization thus indirectly train 88 healthcare providers from these facilities. By doing this we will indirectly ensure that at least 8,800 PLWHA receive quality care from these facilities and organizations. We will also have joint support supervisory visits to the facilities and organizations. KEY LEGISLATIVE ISSUES ADDRESSED Through the adult basic care and support activities we will ensure gender equity in access to these services for both male and female PLWHA. We will work with CBOs, networks of PLWHA and FBOs in educational activities and delivery of targeted messages that promote improved general care and support of PLWHA and raise awareness on HIV and AIDS thus reducing the issue of stigma and discrimination. EMPHASIS AREAS No individual emphasis area exceeds 50% of effort, but they are evenly spread over commodity procurement, training, human resources, community mobilization and participation, development of networks/linkages/referral systems, and Quality Assurance, Quality Improvement and Supportive Supervision. The highest of these is commodity procurement and training.

ACTIVITY DESCRIPTION This activity will be linked to activities in Basic Care and Support HBHC ( 6675) , Prevention of Mother to Child Transmission PMTCT(6683) Counseling and Testing (6681),Strategic Information (6674),Basic Health Care and Support (6675)through community and faith based organizations (CBOs & FBOs) and home based care programs. AIDS Relief's strategy for TB/HIV is to ensure that all HIV positive clients in our Local Partners Treatment Facilities (LPTFs) are routinely screened for TB while TB patients have HIV counseling and testing (CT). Dually infected cases will be offered appropriate care within and outside the LPTF. 24,769 HIV positive patients in care at the 28 LPTFs and 10 satellite sites will be screened for signs of TB and from these, 15% (3,715) are expected to be diagnosed with active disease and will be treated for TB. In addition, HIV testing will be done at 28 DOTS sites in 14 states with referral of HIV positive clients to ART sites. This will be in collaboration with State and National Tuberculosis and Leprosy control programs (STBLCP and NTBLCP). We will implement CT in existing TB DOTS centers and also co-locate TB DOTS centers in all our LPTFs that don't currently have TB screening services. Activities in these existing DOTS centers will be to build the capacity to provide CT to all TB patients and to refer them to AIDSRelief HIV care and treatment sites, as outlined in our VCT narrative. All TB/HIV patients will be put on Cotrimoxazole Preventive therapy (CPT) as this has been demonstrated to reduce morbidity and mortality rate among them. Laboratory infrastructure will be upgraded and human capacity developed to ensure adequate TB diagnosis for patients infected with HIV. We will provide diagnostic equipment including light microscopes, commodities for sputum smear microscopy and Chest X-Ray services. Infection control will be through proper specimen collection, waste disposal, proper ventilation, patient triage and administrative control activity such as active identification of those with TB symptoms and patient segregation. We will develop joint adherence strategies for patients on ARV and TB DOTS and strengthen the facilities capacity to meet specials needs of persons living with HIV/AIDS on ART and anti-TB treatment. Nosocomial transmission of TB to HIV+ patients will be prevented through measures and principles such as basic hygiene, proper sputum disposal, and good cross ventilation at clinics. Facility co-location of TBHIV services is preferred to clinic co-location. The national guidelines on infection control on co-located sites will be implemented in all our sites. Patients screened and treated for TB and TB/HIV will be entered into the updated reporting tool provided by the NTBLCP with appropriate linkage of medical records between TB and HIV. We will train 78 medical records staff on data collection for suspected and diagnosed TB cases, 62 healthcare providers for the dual TB and HIV clinical management and care and 80 community health workers, treatment support specialists including PLWAs to assist with patient adherence to ART and anti-TB drugs. We will hire a TB/HIV focal person for the management of this program area. Indirectly we will target 3 family members for every PLWHA accessing TB/HIV services by use of community health care providers to track their family members and bring them for TB screening and appropriate care. In COP06, we had TB DOTS centers at 3 LPTFs in 3 states of Plateau, Kano and Kaduna. In COP07 we will do the same at 28 LPTFs in15 states of Anambra, Benue, Edo, FCT, Kaduna, Kano, Kogi, Nasarrawa, Ondo, Rivers, Taraba, Adamawa, Enugu, Ebonyi and Plateau. CONTRIBUTIONS TO OVERALL PROGRAM AREA TB/HIV care through collaborative activities with NTBLCP will contribute up to 10% of emergency plan TB/HIV care in Nigeria. The planned co-location of TB DOTS centers in all AIDSRelief LPTFs will expand access to quality services which is currently limited in areas where AIDSRelief is active. This improved access will result in higher TB case detection and outcome results. The systematic implementation of TB/HIV collaborative activities by AIDSRelief will contribute to Nigeria 5 Year Emergency Plan strategy which is expected to result into synergies to contain high TB prevalence rates and also improve the overall health system. These synergies are in the areas of capacity building partnership strengthening and advocacy, joint monitoring of TB and HIV/AIDS activities at all levels, TB care as part of HIV counselor training and improving patient management through community based care thus reducing the burden of TB among PLWAs. LINK TO OTHER ACTIVITIES This activity will be linked to activities in Basic Care and Support HBHC (6675), Prevention of Mother to Child Transmission PMTCT(6683), Counseling and Testing (6681),Strategic Information (6674), Basic Health Care and Support (6675) through community and faith based organizations (CBOs & FBOs) and home based care programs. This will be in collaboration with the 7-Diocese program of CRS and other FBOs and CBOs. HVTB activities will be linked to HVSI (3.3.13) with improved tools and models for collecting, analyzing and disseminating TB/HIV data and also the new approved NTBLCP tool for reporting. The activity is also linked to HVCT (3.3.09) activities to ensure that CT is done for all TB cases. It will be Linked to MTCT (3.3.01) to ensure that HIV positive

pregnant women are screened for TB, those infected treated to reduce the risk of transmission to the baby postpartum and to the community and also reduce the mother's morbidity and mortality. POPULATION BEING TARGETED The target population is all PLWHAs enrolled into the care and support program at our all of our LPTFs. The trend of tuberculosis by gender and age showed that there are more infected women aged 25-44 years old and thus we will targets women and in particular pregnant mothers living with HIV and AIDS and enrolled into the PMTCT program. Families of TB/HIV infected patients will also be targeted as they are at risk of developing TB if in contact with an infected person with open TB. Indirectly we will target 3 family members for every PLWHA accessing TB/HIV services by utilizing community health care providers to track their family members and bring them down for TB screening and place them on appropriate care. KEY LEGISLATIVE ISSUES ADDRESSED This activity will increase gender and age equity by ensuring access to TB/HIV services for young women who account for 41% of TB cases in Nigeria and about 60% among the PLWAs screened for TB at our LPTFs. We will also develop educative and preventive messages targeted at young girls and women to ensure that they seek TB/HIV services in a timely manner and also train our community out reach workers to deliver such messages effectively. EMPHASIS AREAS This activity has major emphasis on human resources to meet immediate workforce requirements and minor emphasis on infrastructure to support TB/HIV and TB DOTS programs, needs assessment, quality assurance, training, development of linkages/referral and networks, education and communication materials in collaboration with the STBLCP.

ACTIVITY DESCRIPTION This activity is also linked to HMBL (6676), HVTB (6677), HVCT (6681), HTXD (6682), HTXS (6678), HLAB (6680) and CRS-SUN (6686). It also relates to HMIN (3.3.04) provided by PEPFAR partners.

AIDSRelief (AR) has a family centered approach for the care and treatment of Persons Living with HIV and AIDS (PLWHAs) and those affected by the epidemic especially orphans and vulnerable children (OVCs). Our OVC activities (6679) include Pediatric basic care and support and pediatric TB/HIV care. Significant changes will include establishment of specific OVC services from 3 Local Partner Treatment Facilities (LPTFs) in COP06 to 26 sites in 11 states in COP07 to provide OVC services to 2,239 clients. We will ensure that the OVC in our care get access to the full package of care including counseling and testing (CT), nutritional counseling/support, psychosocial support, education and economic empowerment by connecting them to other OVC programs in particular the Catholic Relief Services (CRS) under the Scale Up Nigeria (SUN Project). We will participate in advocating the Government of Nigeria (GoN) at the state levels for welfare services for OVCs (free primary education)

In order to increase skills in pediatric HIV/AIDS care we will train 60 health care providers using the Government of Nigeria (GoN) national tools and guidelines. These will be trained in the clinical management of pediatric HIV+ clients including management of TB and other opportunistic infections (OIs), pediatric counseling and support for treatment adherence. Specific training will be provided to at least one pediatric doctor per LPTF for the early detection and treatment of TB, Pneumocytic jiroveci pneumonia (PCP) and Lymphoid Interstitial Pneumonitis (LIP). In addition AR will train pediatric counselors to meet the special needs of children and their parents/care givers and provide the support needed at family level by working with home based care programs under the 7-Diocese program of CRS (6686).

AR will provide laboratory diagnosis and monitoring for OIs and TB infection among the pediatric HIV+ clients. We will provide CD4 testing for all HIV+ OVCs and ensure that those needing antiretroviral treatment (ART) receive it from the ART service program. We will use a family centered approach which provides comprehensive HIV/AIDS care and treatment services to families and encourages other household members to be tested. A home based care package addressing children's diseases that have a high prevalence such as malaria and diarrhea will be provided to include Insecticide Treated Mosquito nets (ITNs), nutritional supplements including micronutrients and Water guards for safe drinking water.

AR will provide facility based care for the OI and TB/HIV of OVCs under the care of the community based programs (CBOs) such as the SUN project in the states where we will be working but the costs of OIs will be met by them and CRS SUN will report these targets (no duplicative counting will occur). We will work with at least 2 other facilities in each state of our operation (State and FBOs), include 3 health workers at each, a total of 66 in our training activities and through this approach indirectly benefit 14,650 OVCs estimated to be under their care. We will carry out joint monitoring and evaluation of these activities with the concerned institutions on a quarterly basis using nationally approved tools that allows the monitoring of services provided directly by AR and those by referral from AR to another organization or leveraged from other donors.

In COP07 we will provide OVC services at 26 LPTFs across 11 states of Anambra, Benue, Edo, FCT, Kaduna, Kano, Kogi, Lagos, Nasarrawa, Oyo and Plateau.

CONTRIBUTION TO OVERALL PROGRAM AREA Pediatric patients represent 10% of AIDSRelief's treatment targets, with many pediatric patients being identified for basic care and support and TB/HIV services. The total number of OVC targeted COP07 is 2,239 including 809 on non-ART care and 1,430 on ART. In addition, our scaling up of OVC services will contribute to the USG/ PEPFAR target of providing comprehensive quality of care to 400,000 children infected and affected by HIV and AIDS in Nigeria.

The OVC activity will contribute to AIDSRelief overall comprehensive package of care for PLWHAs be ensuring that children's specific needs are taken care of. Our training activities

will contribute to the overall program sustainability by building a knowledge base across our 26 LPTFs and 22 other sites.

LINKS TO OTHER ACTIVITIES This activity is linked to HMIN (3.3.04), HMBL (6676) to ensure OVCs are protected from HIV infection through safe injection and blood transfusions when they need them. It is linked to HVTB (6677), HVCT (6681), HTXD (6682), HTXS (6678), and HLAB (6680) by linking OVC to these services and thus comprehensive HIV and AIDS services.

We will collaborate with the SUN project in all sites where these programs co-exist to enable OVCs in our care have access to psychosocial support and other services. AR will also collaborate with community based organizations for the provision of community and home based care service to the OVC clients and nutritional support. AR state program managers and referral coordinators will ensure that OVCs under our care are linked to these other services as described in section 1 above. We will sub grant the SUN project (6688) and other CBOs for these services and monitor service delivery on a monthly basis.

POPULATION BEING TARGETED This activity will target 2,239 OVCs including 809 on non-ART care and 1,430 on ART plus Caregivers of OVCs and Community Based Organizations. Most of AR sites have a community based component that will ensure comprehensive access to OVC services.

We will indirectly target 14,650 OVCs by working with 22 other facilities/organizations in the states where we operate. 66 personnel from these sites will be included in our training activities.

KEY LEGISLATIVE ISSUES ADDRESSED The activity will ensure gender and age equity in access to basic care and support and TB/HIV services to both male and female OVCs in AIDSRelief supported LPTFs.

EMPHASIS AREAS The activity has Major emphasis on commodity procurement and minor emphasis on training, human resources, community mobilization and participation, development of network/linkages/referral systems and linkages with other sector initiatives.

ACTIVITY DESCRIPTION This activity also relates to activities in ARV services (#6678), ARV drugs (#6682), laboratory (#6680), care & support (#6675) and TB/HIV (#6677) AIDSRelief (AR) will increase support for Voluntary Counseling and Testing (VCT) services from 12 local partner treatment facilities (LPTFs) in COP06 to an additional 54 in COP07. Of the 66 sites, 28 will be comprehensive health care centers (LPTFs), 10 satellite sites and 28 stand alone DOTS sites. An emphasis will be placed on expansion into rural areas. The DOTS sites will be evaluated for potential upgrading to comprehensive centers in COP08. 70,000 persons will receive HIV counseling & testing and receive their results. This includes 60,000 adults and 10,000 pediatric clients. AR will build capacity at existing and new LPTFs to enable them integrate VCT services with their care and treatment systems to ensure sustainability. We will train and retrain 340 individuals on counseling and testing using the Government of Nigeria (GoN) VCT training guidelines. This number will include 180 LPTF staff and 160 community volunteers. This will ensure the availability of a pool of trained counselors to ensure continuity. In the comprehensive care centers, we will offer provider-initiated opt-out counseling and testing and scale out VCT services through a community based approach including mobile and community based VCT services. These will be monitored by LPTF's trained counselors (monthly) and AR technical personnel (quarterly) to ensure quality of testing done. 28 LPTFs will be supported to co-locate TB DOTs centers, routinely offer HIV testing to all TB patients and routinely offer VCT to all patients seeking health services. Our policy supports couple counseling and provision of full and accurate information to all clients on all HIV prevention methods. Our sites will promote couple counseling and trained counselors will encourage couples to seek counseling and testing together. Counselor training will include couple counseling to strengthen this program. We will promote VCT as a necessary and important arm of HIV prevention in terms of averting new infections and providing treatment for those in need. All LPTFs will provide same day results and will use the testing algorithm that is in accordance with Nigeria's Interim National Testing Algorithm. This includes the use of Determine and Stat Pak for rapid HIV tests and Genie 11 for discordant results. The USG team will provide us with the test kits but we will directly oversee the warehousing, storage and distribution to LPTFs of the test kits. Stock out cards will be used for the monitoring of test kits usage by the LPTFs. Our VCT sites will use the GoN Heart-to-Heart logo. AIDSRelief will collaborate with faith based and community based organizations and in particular the 7-Dioceses program of Catholic Relief Services in carrying out community based and mobile VCT services. We will collaborate with state and local government VCT programs by carrying out joint trainings and monitoring visits. AIDSRelief will collaborate with FHI/GHAIN who will carry out VCT services including mobile VCT services for a total of 30,000 clients to be counseled and tested. These will be in the vicinity of our ART LPTFs where those testing HIV positive will be referred to. We will also collaborate with FHI/GHAIN for training activities and provision of IEC and other VCT materials. GHAIN will report direct targets for these VCT services. We will carry out quarterly monitoring visits and semiannual refresher courses to ensure quality assurance/control. All LPTFs will use a standard VCT data collection tool for monitoring and evaluation of activities. Our cost per direct target is US$14.64 which is higher than the recommended $10 because 50 of our testing sites will be new and will thus require intensive training and renovations/refitting of counseling rooms. We will directly support 2 DOT centers per state in the 14 states (28) for the routine HIV screening of TB patients. In COP06, we provided VCT services at 12 LPTFs in Benue, Edo, FCT, Kaduna, Kano and Plateau. In COP07, we will extend VCT services to 62 LPTFs in 15 states of Anambra, Benue, Edo, FCT, Kaduna, Kano, Kogi, Nasarrawa, Ondo, Rivers, Taraba, Adamawa, Enugu, Ebonyi and Plateau. CONTRIBUTIONS TO OVERALL PROGRAM AREA AIDSRelief will extend VCT services to 62 partners at the primary and secondary levels in rural and previously underserved communities provide service to 70,000 clients including 10,000 children thus contributing to the PEPFAR and GoN targets for increasing access to counseling and testing. The VCT services will enable the identification of HIV positive individuals in a timely manner and help feed into the care and treatment services. Enhanced testing will also support AIDSRelief's target of placing a minimum of 12,700 new clients on ART in COP07. In addition, the VCT services will add to the prevention strategies of averting new infections through efficient and effective post testing counseling and patient education. VCT services will further contribute towards the national goal of universal access to HIV and AIDS services. By building LPTF capacity through training, salary support to faith based institutions and refitting of LPTF counseling rooms, we will help contribute towards sustainability of VCT activities at these sites and in Nigeria. LINKS TO OTHER ACTIVITIES This activity also relates to activities in ARV services (#6678), ARV drugs (#6682),

laboratory (#6680), care & support (#6675) and TB/HIV (#6677). This is to ensure that all clients testing HIV+ have their CD4 tests done and those qualifying for ART services get it and the rest referred to basis care and support services. We will establish referral linkages with national TB DOTs centers to ensure that TB patients are routinely screened for HIV and those testing HIV+ referred to our LPTFs for HIV and AIDS care. Our LPTFs will be encouraged ensure collaboration of the AIDSRelief program with other departments to provide routine VCT services to all patients and ensure that those testing HIV+ are referred for appropriate care. POPULATIONS BEING TARGETED This activity targets the general population and in particular TB patients, orphans and vulnerable children as well as other at risk populations. The expanded VCT services will involve a network of faith based organizations thus increasing access to community members who may be uncomfortable in medical settings. KEY LEGISLATIVE ISSUES ADDRESSED The expansion of free VCT services will ensure gender equity in access to VCT services by rural and previously underserved communities and ensure that HIV+ people are identified and linked to timely life saving ART services and HIV negatives are educated on the importance of avoiding risky behaviors. Our community based VCT services that include community awareness on HIV and AIDS will help raise community awareness and reduce stigma and discrimination associated with HIV and AIDS. EMPHASIS AREAS This activity has major emphasis on training and minor emphasis on community mobilization, infrastructure, quality assurance, quality improvement and supportive supervision plus the development of linkages/referral systems.

ACTIVITY DESCRIPTION AIDSRelief will procure ARV drugs in COP07 to treat 18,304 patients including 16,474 adults and 1,830 children. Our supply chain management system (SCM) ensures that the necessary infrastructure, systems and skills are in place for efficient forecasting, procurement, storage, distribution and use of quality and efficacious ARVs to our Local Partner Treatment Facilities (LPTFs) with effective monitoring and evaluation. Assessment of new sites follows the AIDSRelief Information Gathering Tool and the Pharmacy Support and Assessment Standards Checklist. Pharmacies will be refitted to improve commodity security. Technical support to LPTFs to institutionalize standard operating procedures (SOPs) for drug management is ongoing. We will train 78 pharmacists and 60 doctors in SOPs. The SOPs are in line with national SOPs are for drug requests, receipts, recording, dispensing, discrepancy reporting; temperature control and disposal of expired drugs. We use the same SCM for ARVs and for laboratory reagents (CD4-test kits) but use ARV service funds to buy lab reagents. CHANPharm is the first source for palliative care drugs for our LPTFs for quality reasons but LPTFs can buy them elsewhere. Procurement follows USG and NAFDAC regulations and is consistent with National Treatment Guidelines. NAFDAC importation waivers are secured for unregistered drugs. We contract with IDA and Phillips pharmaceutical for procurement, CHANPharm for warehousing and distribution. We will substitute innovator proprietary ARVs with FDA approved generic equivalents taking into consideration issues of safety, quality and cost. The Pharmaceutical Management team manages country operations with a Therapeutic Drug Committee (TDC) of clinicians, pharmacists, strategic information advisors and program managers. The TDC reviews drug utilization patterns across all LPTFs, assesses scale-up progress and develops required technical support plans. The TDC is replicated at LPTFs to ensure ARV SCM is clinically informed and logistically supported. Quality assurance covers the entire spectrum from procurement to dispensing. All our ARVs are from Good Manufacturing Practice certified sources, FDA registered and for generics all batches are tested by an independent laboratory (VIMTA) in India or CENQAM, North West University, South Africa for compliance with all requirements before shipping. They are warehoused and transported under air conditioned environment in country and have goods in transit insurance cover. The LMIS used includes a web-based enterprise inventory and financial management system that allows drug tracking from procurement to dispensing and interfaces with the ART Dispensing Software developed by MSH RPMPlus Program installed at LPTFs. The LMIS will be harmonized with the national system. In COP06, we provided ARV drug services at 12 LPTFs in 6 states. In COP07, we will extend services to 28 LPTFs in 15 states of Anambra, Benue, Edo, FCT, Kaduna, Kano, Kogi, Nasarrawa, Ondo, Rivers, Taraba, Adamawa, Enugu, Ebonyi and Plateau, and to 10 satellite sites. CONTRIBUTION TO OVERALL PROGRAM AREA The ART drug activity will ensure that quality ARVs are supplied to all patients in a timely manner. Appropriate product selection and forecasting will ensure the effective use of scarce resources. By scaling out our ARV drug services to 16 new LPTFs in COP07 (Mostly rural based primary and secondary faith based facilities), we will contribute towards the national and PEPFAR plan of availing ARV drugs to previously underserved communities. As expansion of ARV drug services is prioritized to rural areas, we will strengthen existing referral channels and support network coordinating mechanisms. By providing ARV drug services to 18,304 clients, the activity will help to meet the PEPFAR target of providing ARV drugs to 2 million PLWAs by 2009 and to the Government of Nigeria's (GoN) plan for universal access to ARV drugs by 2010. The capacity of the AIDSRelief country program and LPTFs to take on this responsibility will be strengthened in COP07 to enable them take on this role in future thus contributing to the overall program sustainability. This includes our contracting with local distribution agents (CHANPharm), helping LPTFs integrate ARVs and other hospital drug management systems and ongoing technical assistance to LPTFs. In this way local capacity is built to ensure that the ARVs SCM system from forecasting, warehousing, distribution and utilization monitoring is sustained and done at the national and local levels. By proactively switching to generic ARVs we will contribute to ARV price reduction making them more affordable and thus contribute to the sustainability of their supply to PLWHA. LINKS TO OTHER ACTIVITIES This activity is linked to HTXS (3.3.11), MTCT (3.3.01), HBHC (3.3.06), and HTXS (3.3.11) thus ensuring continuity of services to all of our clients. It is also linked to HLAB (3.3.12) and HTXS (3.3.11) by providing the supply chain for lab reagents and HVSI (3.3.13) for LMIS services and to adherence support through the HTXS (3.3.11) activity. We will continue collaboration with other IPs including HARVARD, GHAIN and IHV-ACTION for information sharing on procurement mechanisms and for sharing of supplies when unanticipated delivery delays occur. We will continue collaboration with the GoN in the harmonization of procurement and forecasting for ARVs.

Opportunities for leveraging on expertise in training will be actively pursued. The program will, as part of the global AIDSRelief effort, proactively identify areas of collaboration with USAID's SCMS project for long term harmonization and local sustainability. POPULATIONS BEING TARGETED The activity targets all PLWHAs qualifying for ART according to WHO and GoN guidelines including women from PMTCT clinics and children from OVC programs. In COP07, ARV drugs will be provided to maintain 5,604 existing patients and treat 12,700 new patients to reach a total of 18,304 patients of whom 1,830 will be children using only USG funds. If AIDSRelief were to get a further 30% of ARV drug need from the GoN, we would extend ART drug services to an additional 3,800 patients including 380 pediatric patients. KEY LEGISLATIVE ISSUES ADDRESSED AIDSRelief will continue to work with the GoN and NAFDAC to ensure that policies and legislation enacted prioritize increasing ART access by prioritizing registration of ARV drugs and post marketing surveillance to ensure quality of ARVs on the market. EMPHASIS AREAS This activity has major emphasis on commodity procurement and minor emphasis on logistics, training, quality assurance, quality improvement and supportive supervision plus linkages with other sectors and initiatives.

Track 1 and 2 funds are combined for this activity ACTIVITY DESCRIPTION This activity relates to activities in Counseling and Testing (#6681), MTCT (#6683), HBHC (#6675), HVOP (#6735 ) HVTB (#6677), and HKID (#6679). AIDSRelief (AR) through the primary and secondary faith based networks will extend ART services to more underserved rural communities with no existing ART services. In COP07, ART services will be increased from 12 COP06 Local Partner Treatment Facilities (LPTFs) to 28 LPTFs across 15 states and 10 satellite sites. Comprehensive ART services will be expanded to recruit 12,700 new patients including 1270 children, maintain 5,604 to reach a total of active 18,304 patients including 1,830 children. All LPTFs will have capacity to deliver quality ART services including prevention for positives through counseling and provision of full and accurate information for PLWA including discordant couples. Each LPTF will recruit a coordinator to promote prevention for positives activities that will be monitored by the AR program managers in each state. AIDSRelief will continue to participate in Government of Nigeria (GON) harmonization activities and to participate in the USG coordinated Clinical Working Group to address ongoing topics in ARV service delivery. In COP06, we trained 74 doctors, 148 nurses, 100 counselors and 140 community volunteers. Bringing on the 16 new LPTFs in COP07 will involve a 2 week pre-site activation intensive didactic and practical training followed by ongoing capacity building. In COP07 we will train an additional 690 health workers including 60 physicians, 120 nurses, 200 adult ART counselors, 30 pediatric counselors, 240 adherence counselors and 300 community volunteers including PLWHA. 315 health workers of the 690 will be trained in pediatric ART services. Training includes ART clinical care, treatment adherence and laboratory monitoring. There will be intensive patient treatment preparation before ART initiation, ongoing treatment support through the use of treatment support specialists, community volunteers and PLWHA. We will have specific pediatric ART and counseling training using one of our established sites in Jos for practical trainings. Sustainability lies at the heart of our program, and is based on durable therapeutic outcomes to first line regimens and health systems strengthening. In COP07, we will continue to strengthen LPTFs health systems with the support of AR global Health Systems Management within AR global structure through joint seminars and twining hospitals in Nigeria and other countries and experience sharing with other AR countries. This will include human resource support and management, financial management, infrastructure development, improvements in health management information systems, improvement of operational efficiency with establishment of cost centers and activity budgeting, streamlining of patient flow systems and integration of financial and clinical patient outcome information with other hospital services. We will include 44 personnel from 22 additional sites from 15 states in our training programs for the provision of quality ART services at those sites and for health systems strengthening. In COP06 we supported 12 LPTFs in 6 states. We will add 16 new LPTFs in COP07 to support a total of 28 LPTFs in 15 states of Anambra, Benue, Edo, FCT, Kaduna, Kano, Kogi, Nasarrawa, Ondo, Rivers, Taraba, Adamawa, Enugu, Ebonyi and Plateau, and to 10 satellite sites. CONTRIBUTION TO THE OVERALL PROGRAM AREA: By adhering to the Nigerian National ART service delivery guidelines, and building strong community components to the program, AIDSRelief will ensure that the PEPFAR and GON goals of expanding ARV care to more PLWHA is accomplished in a durable and sustainable manner, and local capacity to deliver high quality care and support for PLWHA is strengthened. This activity is in response to the need to achieve the overall target of PEPFAR to place 350,000 clients on ART by 2009 and also support the Nigerian government's universal access to ART by 2010 initiative. By putting in place structures to strengthen LPTFs health systems we will contribute to the long term sustainability of the ART programs. Our working with 22 additional sites and FB institutions and training 44 additional personnel in ART care and health systems strengthening will further contribute towards GoN/USG goal of scaling up quality ART services and their sustainability. LINKS TO OTHER ACTIVITIES This activity is linked to HVCT (#6681), MTCT (#6683) to ensure that people tested for HIV are linked to ART services; HVOP (#6735) for prevention for HIV positives, HBHC (#6675) for basic care and support services including home based care; HKID (#6679) for OVCs needing ART services and HVTB (#6677) for routine screening and treatment of TB among PLWHA. We will collaborate with FBOs including the 7-D program of Catholic Relief Services (#6686) to establish networks of community volunteers including PLWHA to assist with adherence counseling and provide treatment support for clients on ART. The FBOs will be sub-granted to provide these support services for our ART clients. Networks will be created to ensure cross-referrals and sharing of best practices among our and other implementing partner sites including sharing our training curriculum. We will work with the GoN and other stakeholders to develop networks and cooperating mechanisms for local

partners to address sustainability issues that are bigger than any one of them but with sustainability implications for all. POPULATIONS BEING TARGETED This activity targets PLWHA from rural communities who qualify for ART services as per the WHO staging criteria and GoN guidelines. 18,304 PLWAs will be targeted to receive ART in COP07 including 1,830 pediatric clients. In addition 15% of our ART clients will come through the MTCT activities to ensure these women have access to PMTCTplus services. We will work with a total of 22 sites across the 15 states and train 44 health care workers in ART care, and health systems strengthening for sustainability of ART services in Nigeria. By training these personnel we hope to indirectly benefit at least 3, 220 PLWHA (3,000 adult and 220 pediatric patients) who will be enrolled into the ART services at the 22 sites. These will be both state and faith based facilities that are not directly funded by the PEPFAR program. KEY LEGISLATIVE ISSUES ADDRESSED The ART services will ensure gender and age equity in access to ART services through linkages with OVC and PMTCT services in our sites and neighboring sites. The extension of ARV services into rural and previously underserved communities will contribute to the equitable availability of ART services in Nigeria and towards the goal of universal access to ARV services in the country. The provision of ART services will improve the quality of life of PLWHA and thus reduce the stigma and discrimination against them. EMPHASIS AREAS This activity will include major emphasis on human resources and minor emphasis on commodity procurement, infrastructure development, training, quality assurance/improvement and development of networks/linkages/referral system, community mobilization and participation.

ACTIVITY DESCRIPTION This activity relates to MTCT (6683), HMBL (6684), HVTB (6677), HKID (6679), HVCT (6681), HTXS (6678) and HTXD (6682) by ensuring that appropriate Lab support is provided for lab diagnosis, clinical monitoring and HIV testing. Linkages with HVSI (6674) will ensure tracking of lab infrastructure indicators. AIDSRelief (AR) works in primary and secondary health care facilities to provide quality HIV and AIDS services to people living with HIV and AIDS (PLWHAs). We support Laboratory (Lab) infrastructure to all of our local partner treatment facilities (LPTFs). We provide on-site capacity to test for HIV, laboratory monitoring of disease progression and response to treatment, opportunistic infections (OIs) diagnosis and monitoring of antiretroviral drug (ARVs) toxicity. We don't routinely do Viral load (VL) testing since our LPTFs are mostly primary and secondary level facilities, but ensure that VL testing is done on a sample of our clients from each LPTF at Institute of Human Virology (IHV-ACTION) supported laboratories when appropriate. AR will expand infant diagnosis for PMTCT in its primary care facilities by ensuring that dried blood spots (DBS) samples are collected and sent to UMD ACTION labs for diagnosis. Standard operating procedures (SOPs) for sample transport for testing and receipt of results will be developed. The SOPs include procedures for blood collection in vacutainers, for viral load, correct labeling and then transporting by LPTF lab personnel to ACTION labs for processing. We will train LPTF lab personnel on procedures for preparing, storing and transporting DBS samples to be taken to ACTION labs for PCR. We will work with ACTION to procure storage and transport equipment like vacutainer boxes and liquid nitrogen containers. Based on developed SOPs between AR and ACTION, our vehicles will move stored patient samples from LPTF to ACTION labs and collect the results. AR will continue to participate in the USG-Nigeria coordinated Laboratory Working Group to ensure harmonization with other IP and the Nigerian government. We provided lab equipment and reagents to 12 LPTFs in COP06 and will do the same for the 16 new LPTFs in COP07 and continue to supply Lab reagents to all the 28 LPTFs. We will provide automated CD4 testing equipment, cytospheres for manual CD4 testing as backup, hematology analyzers, chemistry machine and binocular microscope that are easy to use and appropriate for primary care centers. 10 new satellite sites will have a lower level of laboratory capacity. All equipment will be centrally procured and shipped to Nigeria. AR will hire 3 new full-time in country lab specialists who will be responsible for equipment installation, initial and follow up trainings and monitoring of quality assurance and quality control (QA/QC) activities. These will be supported by a Baltimore based lab specialist. AR will use its reagent forecasting tools at all levels to determine consumption and predict need, to forestall stock outs. AR will centrally procure lab reagents from manufacturers locally and abroad and distribute to LPTFs. HIV Test kits will be provided directly by USAID through the SCMS mechanism. Thirty-six (36) lab personnel were trained in COP06 and 82 will be trained in COP07. Most of our LPTFs have less than 3 lab personnel per site and we train all of them. We emphasize a hands-on training during laboratory start up in lab techniques and lab management. Refresher trainings are done at six months and periodically as per identified needs at each LPTF. We provide simplified lab manuals to reinforce each training episode. The onsite trainings are done by AR technicians in collaboration with IHV-ACTION tertiary lab specialists. We use Nigerian Institute of Medical Research Training Manuals to supplement simplified manual from IHV-University of Maryland. Ongoing QA/QC is done onsite, at IHV ACTION tertiary labs, and a small percentage at IHV Baltimore as a 2nd line of QA/QC. AR sub-contract to IHV ACTION for this service. AR lab personnel and selected partner personnel (3 in total) will participate in the training of trainers (TOT) lab management program to be provided by Association of Public Health Labs, with support from USG-Nigeria. They will then transfer the knowledge gained to the 82 LPTF personnel using the provided training materials. We will work with other sites (State and Faith based) across the 15 states of our operation for a total of 22. At these 22 sites we will include a total of 44 lab personnel (2 per site) in our training activities. The lab personnel will be trained to effectively provide quality lab services (2,399 each a total of 62,374 tests for COP07) for a total of 3,220 patients (124 per site). In COP06 we supported Lab infrastructure in 12 sites in 6 states of FCT, Benue, Edo, Kaduna, Kano and Plateau and will do the same for an additional 16 new sites in COP07 in 15 states of Anambra, Benue, Edo, FCT, Kaduna, Kano, Kogi, Nasarrawa, Ondo, Rivers, Taraba, Adamawa, Enugu, Ebonyi and Plateau, and to 10 satellite sites. CONTRIBUTIONS TO OVERALL PROGRAM AREA By supporting Lab infrastructure at all of our LPTFs, AIDSRelief will help them carry out 286,785 tests including 190,861 rapid HIV tests for 91,000 clients (10,000 children and 81,000 adults), 74,871 HIV monitoring tests and 21,053 TB/OIs tests This will contribute to the PEPFAR target of preventing 1,145,545 new infections in Nigeria by 2010. The activity will also contribute to AIDSRelief's target of

providing quality ART services to 18,304 clients including 16,874 adults and 1,830 pediatric patients in COP07. This activity will also contribute to the reduction in Mother to child transmission of HIV and early detection of any infant HIV infection by ensuring that DBS are provided for. The activity will further contribute to the reduction and early detection of any treatment failures among our clients by providing for VL tests for a subset of the 18,304 ART clients in COP07. This will support the possible need for ARV regimen switch for patients failing on first line regimens. The activity will also provide infrastructure and training for TB diagnosis for the 31,000 clients in care at the 28 LPTFs. The activity will contribute to the overall program sustainability by improving Lab infrastructure and by building capacity among primary and secondary level facilities. LINKS TO OTHER ACTIVITIES This activity relates to MTCT (6683), HMBL (6684), HVTB (6677), HKID (6679), HVCT (6681), HTXS (6678) and HTXD (6682) by ensuring that appropriate Lab support is provided for lab diagnosis, clinical monitoring and HIV testing. Linkages with HVSI (6674) will ensure tracking of lab infrastructure indicators. We will collaborate with IHV- ACTION, other implementing partners and state hospitals to optimize resources and strengthen the comprehensive networks of care across the 15 states including centralized lab training, establishment of high level laboratory services for VL testing and DBS. We will collaborate with the state and other faith based facility labs by including 44 lab personnel from 22 facilities in our training activities and by sharing our training manuals. AR will link LPTFs with local procurement and distribution agents such as CHANPharm to ensure a sustainable supply chain for lab reagents. Our regional program managers will act as network coordinators.

ACTIVITY DESCRIPTION This activity relates to all HIV/AIDS activities particularly PMTCT (#6683), Basic Care and Support (#6675), TB-HIV (#6677), OVC (#6679), Counseling and Testing (#6681), ARV Services (#6678), ARV Drugs(#6682), and Laboratory Infrastructure (#6680). This activity is coordinated by Constella Futures, one of AIDSRelief's consortium member. AIDSRelief's Strategic Information (SI) activity incorporates program level reporting and setting up of both paper-based and computerized Health Management Information Systems (HMIS) for our Local Partner Treatment Facilities (LPTFs). AIDSRelief has built a strong Patient Management Monitoring (PMM) system, using in-country networks and available technology for 12 LPTFs in COP06 and will, in COP07, continue to provide improvements in the system while expanding to an additional 16 LPTFs and 2 PMTCT sites in 15 states with an added emphasis on harmonization with the Government of Nigeria's (GoN) emerging National PMM system. As part of our capacity building and contribution to program sustainability we provide logistical support for automated PMM to our LPTFs by providing them with computers and other logistical support systems. All the 12 COP06 LPTFs were provided with these and we will do the same for the 16 new COP07 LPTFs and 2 PMTCT sites. A total of 652 LPTF and PMTCT personnel will be trained in the PMM to ensure that all health workers coming into contact with patient records use them appropriately. We will continue to provide Technical Assistance (TA) to LPTF's and PMTCT personnel to adapt and harmonize existing records to meet the standards of the GoN and ensure proper roll-out of GoN's revised forms. We will carry our centralized CAREWare training and on-site PMM trainings including ongoing TA to LPTFs. Our SI team will carry out regular site visits and reviews to ensure data quality and data validation. LPTFs will be given feedback on the routine reports submitted to ensure program ownership. Additionally, our SI team will continue to be active participants on the SI working group established and coordinated by USG-Nigeria. In an effort to assist partners to analyze and interpret their patient data, simple procedures using recognized statistics, specifically Life Table Analysis (LTA), will be conducted with publicly-available software. These procedures compute program continuation rates from existing medical records maintained by the ART program. We will train LPTFs personnel to enable them continue to conduct these LTAs independently and thus contribute to the sustainability of this activity. Due to the limitations of the CAREWare software currently being used by all 9 AIDSRelief countries, we are working towards transiting to IQCare software, which provides for a more robust open source, freeware solution. This will be introduced pending a decision by the GoN on permissible electronic platform(s) for the National PMM system. In the meantime, CAREWare will be introduced into new COP07 LPTFs and will continue to be supported, developed and enhanced in the existing ones. We will participate in the harmonization process of the existing CAREWare with a National automated PMM system and will transit to the national system when it moves from planning to implementation. In COP06, we provided SI management services to 12 LPTFs in 6 states of Benue, Edo, FCT, Kaduna, Kano and Plateau. In COP07, we will provide support for SI management for 28 LPTFs and 2 PMTCT sites in 15 states of Anambra, Benue, Edo, FCT, Kaduna, Kano, Kogi, Nasarrawa, Ondo, Rivers, Taraba, Adamawa, Enugu, Ebonyi and Plateau. CONTRIBUTIONS TO OVERALL PROGRAM AREA Improvement in SI management capacity of existing and new LPTFs will ensure effective data use and management. By training 652 LPTF staff across the 28 LPTFs and 2 PMTCT sites in 15 states, the activity will contribute to overall program capacity building and sustainability. The provision of logistics for automated PMM will contribute towards the GoN and USG strategy on provision of quality and timely data for decision making. The LTA will provide vital feedback to LPTFs regarding trends in retention to care, follow-up appointments, and repeat laboratory studies which will serve as a valuable resource in developing corrective action plans that would enhance the efficiency and effectiveness of operations and management of the LPTFs. LINKS TO OTHER ACTIVITIES This activity relates to all HIV/AIDS activities particularly PMTCT (#6683), HBHC (#6675), HVTB (#6677), HKID (#6679), HVCT (#6681), HTXD (#6682), HTXS (#6678), and HLAB (#6680) to provide quality data and information for decision making. We will collaborate with GoN at the federal and state levels and actively participate in the SI harmonization process for the introduction of a national automated PMM system. POPULATIONS BEING TARGETED The AIDSRelief SI activity mainly targets our LPTF personnel including those primarily engaged in SI activities (on-site Project Coordinators, M&E officers, data entrants, Medical records technicians) and other health care workers (Physicians, Nurses, Counselors, Pharmacy and Laboratory staff). This is to ensure that all health care providers coming in contact with the patient keep appropriate records and manage them efficiently and effectively. KEY LEGISLATIVE ISSUES ADDRESSED Not applicable EMPHASIS AREAS This activity has a

major emphasis on HMIS and minor emphasis on monitoring, evaluation or reporting for program level data collection, proposed staff for SI, targeted evaluation, logistics, trainings and linkages with other sectors and initiatives.