ACTIVITY DESCRIPTION: CRS/7D will increase access to quality PMTCT services by supporting health facilities and continuing to build community support. The project will work with 12 sites to improve PMTCT services including CT (opt out) with same day results and partner testing, OI treatment and prophylaxis, infant feeding counseling during first and subsequent ANC visits, and ART services for pregnant women. Women requiring HAART are referred to the nearest ART site. For those not requiring HAART, the nationally recommended short course will be available, which includes ZDV from 28 weeks, and single does NVP at onset of labor. For women who present in labor, CT services will be offered and a regimen of NVP single dose stat and ZDV every 3 hours throughout labor will be available. The infant prophylaxis regimen will consist of single dose NVP with ZDV. Co-trimoxazole will be provided to exposed infants pending a negative diagnosis. Infants will be referred to appropriate sites for early infant diagnosis.

Supervisory visits to each site will be made by monthly by diocesan staff, quarterly by CRS staff, and twice per year by USG/GON/IP personnel. Volunteers will be sensitized to disseminate correct and appropriate information on PMTCT and maternal nutrition/safe infant feeding practices. Volunteers will support mothers infant feeding choices through on-going counseling.

Targets include CT for 15,750 pregnant women with 14,500 receiving results, 1000 pregnant women placed on ARV and training of 44 health care workers using national PMTCT curriculum in 12 sites. Indirect targets are from zonal trainings on PMTCT for LGA staff and periodic support visits by partner staff to LGA health facilities.

Diocesan staff will support PMTCT services in 10 states and the FCT (Kogi, Benue, Plateau, Nassarawa, Niger, Kaduna, Lagos, Cross River, Ebonyi and Edo States). In COP07 4 of these health centers will expand their services to include ART and will be funded by AR. 5 centers will be added to the remaining 7 original COP06 sites for a total of 12 sites. These centers require financial and technical investment for startup.

Plus Up funds will be used to overcome human resource constraints faced by the project, and therefore no changes in targets will result. PMTCT Specialists will be hired to respond to immediate and long term PMTCT needs. They will also reinforce the 7D collaboration with AIDSRelief in leveraging resources and expertise through the formation of a PMTCT Team that will plans and implement 7D, AIDSRelief and partner PMTCT needs coherently. Partner capacities will be enhanced through hiring PMTCT specialists to be managed by the Abuja province but attached to the 7D/AR PMTCT Team for a period. PMTCT trainings of diocesan PMTCT Coordinators will be conducted. Plus up funds will also be dedicated to new solutions for reaching women who attend ANC but do not deliver at a hospital. Some ANC clinic refurbishments will also be undertaken where necessary.

CONTRIBUTIONS TO OVERALL PROGRAM AREA: Activities that were conducted in year 2006 that will continue in 2007 include voluntary counseling and testing (CT), home-based care (HBC), and support groups for HIV+ pregnant women. These PMTCT services will contribute to several of the PEPFAR goals. The goal of preventing new infections by offering CT services to pregnant women, as well as providing PMTCT prophylaxis to prevent infecting the newborn child will contribute to preventing new infections. The goal of providing care to HIV infected individuals will also be achieved by the provision of PMTCT services. PMTCT-specific HBC will be provided to the pregnant woman and her family. This will include counseling on infant feeding practices. Support groups will also provide participants with coping mechanisms for addressing stigma, discrimination and will serve to mobilize PLWA to confront these issues in the community. This activity will also contribute to the goal of providing treatment to HIV infected individuals, as women who are eligible for ART will be referred for these services.

Plus up will enable CRS 7D to expand the couple counseling work and to intensify the targeting of men during couples counseling. Plus up funds will also enable partnerships with schools and youth groups to train sensitized youth into active peer educators. Programs will be tailored to in-school and out-of-school youth as a wraparound with OVC education. Primary A will be promoted for in-school youth and secondary A will be promoted for out-of-school. An additional AB specialist position will be added at CRS or a partner level to tailor the IEC materials to men, rural areas and OVC, and to expand these components.

ACTIVITY DESCRIPTION This activity relates to activities in PMTCT 6685, Counseling & Testing 6687, Care & Support 6686.

The first component of the CRS Seven Dioceses (7D) Prevention Project is to continue to support the Catholic Secretariat of Nigeria (CSN) in its role as a training body. CSN will conduct Sensitization Workshops for the Catholic clergy and laity across 10 Arch/dioceses. CRS 7D's Direct support of one service outlet will enable CSN to continue to develop accurate, target-specific and "faith sensitive" Information, Education, and Communication (IEC) materials for use in Arch/dioceses across Nigeria. In addition, CSN will sensitize clergy, religious, catechists, and laity on AB prevention in six additional arch/dioceses yet to be determined. It is expected that with the acquired knowledge on standard AB messages, priests and other leaders in the community will deliver culturally appropriate and effective messages to thousands of people. A total of 150 individuals will be trained in six additional arch/dioceses. CRS will provide direct support to 10 service outlets in 8 7D target states, and an additional six arch/dioceses outside of the 7D target dioceses.

The second component of the 7D project is to support the 10 partners to conduct several HIV/AIDS Sensitization Workshops for the Catholic Church. Groups targeted will include the clergy, catechists, and laity. Activities will include: training, printing of appropriate AB messages in weekly parish bulletins, community mobilization/participation, dissemination of IEC materials and local organization capacity development. In COP07, an additional 80 counselors will be trained on premarital counseling of couples on the importance of A/B. The new couples, the husband in particular, can then act as role models for the community. Youth both in and out of school will be increasingly targeted for A/B interventions. Additional A-specific youth groups will be formed and will actively engage in A-specific interventions such as workshops, skills building, and educational discussion sessions.

The final component of the project includes supporting 10 Arch/dioceses to provide AB Prevention trainings for 192 PLWHA, who have been identified and are currently serving as Support Group Leaders. Those trained are expected to counsel and communicate information about AB Prevention at the support group and household level on an ongoing basis. Health facility staff at the PHC level will benefit from AB Prevention training in order to deliver appropriate messages to clinical patients. CRS 7D will support the establishment of mobile drama groups and community outreach campaigns as a part of A/B Prevention. Post-test and home-based counseling, as well as AB sessions with at-risk groups, will include accurate information about condoms.

Training of community members, including PLWHA, capacity building, and working within existing church structures lays the foundation for sustainable long term programming.

.Indirect support will also be provided by way of materials distribution, technical guidance, and assistance with facilitation of AB events in over 350 parishes. Direct targets will be reached by the delivery of AB messages through community outreach programs to 950,000 individuals, 22,000 of which will benefit from A-specific messages. A total of 422 individuals will receive training. Coverage areas of the activity include the following: Kaduna and Kafanchan A/dioceses (Kaduna), Minna Diocese (Niger), Jos A/diocese (Plateau), Lafia Diocese (Nasarawa), Makurdi and Otukpo Dioceses (Benue), Idah Diocese (Kogi), Benin A/diocese (Edo), and Abuja A/diocese (FCT). The geographic location of the six additional arch/dioceses to benefit from expanded AB activities is to be determined in collaboration with the GON and the USG prevention team.

CONTRIBUTIONS TO OVERALL PROGRAM AREA

Regular delivery of A/B prevention messages in the 10 Arch/dioceses will encourage youth to adopt behaviors to reduce risk of HIV infection such as delaying sexual debut until marriage and promoting social/community norms which favor A/B. Adults in the Arch/dioceses will also be motivated to embrace the message of Being faithful to one partner as means of preventing HIV/AIDS. Role models in the community will further encourage behaviors that reduce the risk of HIV infection.

Prevention is only one aspect of the HIV/AIDS project area. It will encourage the adults and youths to participate in Voluntary Testing and Counseling (VCT) as well as reducing stigma and discrimination against PLWHA. Through the Prevention Project, the community can be linked with resources and programs for HIV/AIDS. In addition, the capacity of local organizations will also be developed. This will contribute to the Emergency Plan's 5 year program goals by preventing new infections and reducing the incidence of HIV infection in Nigeria.

LINKS TO OTHER ACTIVITIES A/B prevention strategies in the 10 Arch/dioceses and neighboring areas relate to VCT6687, Prevention of Mother to Child Transmission (PMTCT) 6685, and Orphan and Vulnerable Children (OVC) 6686 activities. Targeted population in the Arch/dioceses will be linked to VCT centers in the communities in order to ascertain their HIV status.

PMTCT activities and OVC activities have an aspect of A/B prevention. Being Faithful to one partner will be reinforced among all pregnant women that will be attending Ante Natal Care (ANC) clinic under the PMTCT activity. Children under the OVC program will be encouraged to embrace Abstinence, delaying sexual debut until marriage.

POPULATIONS BEING TARGETED Target populations of the A/B Prevention messages include: adults, children and youth, PLWHA, HIV/AIDS affected families, and community leaders. This includes both girls and boys from primary school through university students, as well as adults of both genders with activities specifically tailored for pregnant women. Other target groups include the Catholic clergy and laity.

Plus up will enable CRS 7D to expand the couple counseling work and to intensify the targeting of men during couples counseling. Plus up funds will also enable partnerships with schools and youth groups to train sensitized youth into active peer educators. Programs will be tailored to in-school and out-of-school youth as a wraparound with OVC education. Primary A will be promoted for in-school youth and secondary A will be promoted for out-of-school. An additional AB specialist position will be added at CRS or a partner level to tailor the IEC materials to men, rural areas and OVC, and to expand these components. 422 new individuals were to be trained in COP07. With plus up funds, an additional 80 couples counselors and 131 youth peer educators will be trained for a total of 633 people to be trained in AB. Moreover, Plus up funds will involve the community church "Prayer Leaders" who lead the most community-based unit of the church structure. Each diocese has an average of 300 Prayer leaders who will be trained on AB messages and will reach about 30 community members each. A total of 72,000 direct beneficiaries will be added to the existing target to improve the saturation of the rural areas within the ten target dioceses.

ACTIVITY DESCRIPTION This activities also relates to activities in Prevention of Mother to Child Transmission (#6685), Voluntary Counseling and Testing (#6687), ART Drugs and Services (#6682, #6678, #6773, #6766), OVC (#6688), and laboratory services (#6680)

CRS Seven Dioceses (7D) Care & Support (C&S) Project will increase basic C&S services from 10,600 to 13,062 Persons Living with HIV/AIDS (PLWHA) in 10 Arch/dioceses, and ensure that links are established with Primary Health Care Centers.

CRS 7D will support the provision of a comprehensive palliative care package for PLWHA in 10 Arch/dioceses by strengthening community and health worker capacity to provide these services. Specifically, 7D will provide training for 350 caregivers to increase the capacity at 10 service outlets which will provide a full range of C&S services at Primary Health Care (PHC) centers, mission hospitals and at the household level. The basic C&S package will be attributed approximately as follows: 30% effort on treatment and prophylaxis of OIs; 20% effort on basic lab work, e.g. malaria smears and baseline CD4 count; and 50% effort on Home Based Care (HBC) activities, which include nutrition and hygiene education, and provision of insecticide treated bed nets and water guard. It will enhance delivery of basic C&S to PLWHA through trained community volunteers, health workers and family members. Organizational development support will also be strengthened in the areas of administrative capacity and financial accounting systems for organizations attempting to grow to provide this care on a larger scale.

7D will also standardize the contents and use of HBC kits and will use CRS contributions to provide nutritional supplements where necessary. 7D will engage support groups and community based workers in training activities that will promote improved general C&S of PLWHA. This will include the development of information, education, and communication (IEC) materials and activities that address stigma and discrimination. A total of 800 volunteers will benefit from such trainings.

In order to avoid double counting, it has been agreed that in the three states where 7D and AIDSRelief (AR) have similar service areas (Benue, Kaduna and Edo states), 7D will provide Community and Home Based care services for AR clients, and AR will provide facility-based care.

An expansion of services will also include the development of 2 pilot day care programs. Services rendered at day care facilities include: re-hydration fluids, basic medical care, nutritional interventions, respite care, counseling, and social support. By leveraging current PMTCT PHC sites, the provision of C&S services at those sites will be more cost effective. C&S services, such as the treatment of OIs, will be integrated at PMTCT sites which offer VCT. These sites will be automatically linked to the 7D HBC program. Transportation costs for caregivers and clients with complicated OIs that require a referral to a hospital or specialist services will also be incorporated.

Activities such as zonal trainings on C&S for LGA staff and periodic site visits by arch/diocesan staff for supportive supervision at the LGA health facility level will promote integration and sustainability. Training, capacity building, and working within existing church structures lays the foundation for sustainable programming in the long run. Diocesan staff will support C&S services in 7 states and the FCT (Kogi, Benue, Plateau, Nassarawa, Niger, Kaduna, and Edo States) in a total of 10 sites.

CONTRIBUTIONS TO OVERALL PROGRAM AREA Activities that were conducted in 2006 that will continue in 2007 include provision, treatment and prophylaxis for OIs, lab diagnostics, Home Based Care services, and training in HBC principles. These C&S services will contribute to several of the PEPFAR goals. The goal of mitigating the impact of HIV/AIDS will be achieved by the provision of C&S services. This activity will also contribute to the goal of providing treatment to HIV infected individuals, as adults who are eligible for ART will be referred for these services. Through mutual collaboration and referrals, this activity will further contribute to the national goal and PEPFAR C&S targets.

LINKS TO OTHER ACTIVITIES C&S relates to other HIV/AIDS activities to ensure continuity of care for all persons

accessing C&S through the 7D Care & Support Project. The activity will be linked with Prevention of Mother to Child Transmission (PMTCT) (3.3.01), Voluntary Counseling and Testing (3.3.09), ART Drugs and Services (3.3.10 and 3.3.11 and OVC (3.3.08), as well as OI treatment and laboratory services offered in health care facilities and by other PEPFAR implementing partners or public health facilities. C&S will also be linked to social support services, for all PLWHA in the various communities. Through a strengthened referral network, 7D clients will be referred for advanced management of disease, as necessary. C&S clients in need of ART services are referred to AIDSRelief sites, and when distance becomes an issue, they are linked with the nearest USG and/or GON supported ART site. Children and youth requiring additional services, such as support with school fees and basic medical care, will be automatically registered with the CRS SUN program.

POPULATIONS BEING TARGETED The populations to be served include children and youth, PLWHA and their families, caregivers and widows/widowers within the 10 Arch/dioceses. Through linkages with other program areas (PMTCT, VCT, ART), recently diagnosed HIV positive adults (including TB-HIV) in these communities in need of C&S are also targeted. Pediatric C&S clients will be assisted through a family care approach and referred to the SUN program for additional child-centered services. The funding requested will cover C&S services for 13,062 PLWHA and training for 350 care givers. We will also target religious leaders.

KEY LEGISLATIVE ISSUES ADDRESSED These activities will include an emphasis on reducing stigma associated with HIV status and the discrimination faced by individuals with HIV/AIDS and their family members.

HIV prevention will include gender sensitive activities which will address behaviors, social norms and resulting inequalities between men and women that increase the vulnerability to and impact of HIV/AIDS.

EMPHASIS AREAS The major efforts of the C&S Program activities are spread across the board with equal emphasis on the following: Local Organization Capacity Development and training. Minor emphasis will be placed on the Development of Networks/Linkages/Referral Systems.

ACTIVITY DESCRIPTION This activity is linked to care and support (#6686), PMTCT (#6685), Abstinence and Be Faithful (#6684) and OVC (#6688).

The Catholic Relief Services (CRS)/Seven Diocese Project will provide comprehensive Counseling and Testing (CT), with both stand-alone and integrated CT services, within Catholic mission hospitals, primary and rural health centers, and parishes. The hospitals will be supported in the provision of CT for high numbers of in-patients and outpatients. CT centers will be supported at each health facility and parish for the general population. The requested funding will be used primarily to support the procurement of test kits and associated medical supplies (disposable gloves, etc.), the training of staff in the provision of quality and comprehensive CT including couples counseling, and the training of supervisory staff to ensure a minimum quality standard for services. Test kits, compliant with national HIV testing algorithm, are procured at the arch/diocesan level for parish testing, and distributed monthly. Health facilities, especially rural health centers, procure approved test kits locally to reduce the distribution burden. Arch/diocesan partners generally warehouse test kits in mission hospitals and distribute to rural centre and communities quarterly based on needs. Partners also manage tracking logistics data and local test kits re-supplies with oversight from CRS Program Managers. CRS will continue to support and participate in the harmonization process led by Government of Nigeria (GON) with regard to LMIS and ICS for test kits.

CT strategy includes encouraging individuals to disclose their status to partners and family members, through post test and on going counseling. When necessary, individuals encountering difficulties with disclosure will be referred for spiritual and psychosocial counseling for added support. Post-test and home-based counseling, as well as AB sessions with at-risk groups, include accurate information about condoms. For discordant couples, counselors provide full and accurate medical information, as well as psychosocial support, with regard to specific issues such as fidelity, intimacy and options for having children in order to reduce the risk of infection.

Community outreach to promote CT will be through local Parish Action Committees on AIDS (PACA). There will be continuous community mobilization and awareness to enhance understanding of CT. The most strategically positioned parishes, which benefit from geographic advantages for provision of services, will provide high quality CT services to surrounding communities which are difficult to reach and underserved. Through community-based testing, stigma at the community level will be addressed. Community-based testing will be undertaken with GON approved non-cold chain dependent test kits. The project aims to increase awareness of CT activities by including the national Heart to Heart logo at all of its CT centers.

Collaboration between PEPFAR IPs improves the health care provided to those who test HIV positive, as well as establishes and strengthens a referral network between community groups, social service providers, and health care facilities. 7D will continue to strengthen its own referral network so that clients receive maximum services, such as care and support, PMTCT and ART. Referral Coordinators will receive on-going technical support in order to strengthen referral networks, focusing on CT as an entry point to prevention, care and support, and treatment. CT activities will be carefully monitored on a monthly basis by arch/diocesan staff, primarily the Referral Coordinator, who will collect and monitor monthly CT data. Arch/diocesan and CRS staff will be responsible for monitoring quality and progress of CT sites in their arch/dioceses on a quarterly basis.

Activities will include direct support to 120 service outlets in 11 states that will provide CT according to GON Guidelines. 27,500 individuals, 2,000 of which will be pediatric clients, will be counseled and tested for HIV; 25,000 individuals, 1,600 of which will be pediatric clients, will receive their test results; and 205 individuals will be trained in both counseling and testing according to GON CT training curriculum. Individuals trained will receive a 1-day refresher training every 6 months at the arch/diocesan level. Indirect targets will include the training of LGA health facility staff on CT; and the provision of technical support for CT implementation and monitoring at the LGA health facility level. Training, capacity building, and working within existing church structures lays the foundation for sustainable programming in the long run. Diocesan staff will support CT services in 10 states and the FCT (Kogi, Benue, Plateau, Nassarawa, Niger, Kaduna, Lagos, Cross River,

and Edo States).

As of July 1st, 2006 CRS has provided CT services to 20,086 individuals thus exceeding their targets (17,500) by 2586.

CONTRIBUTIONS TO OVERALL PROGRAM AREA The CT services will further contribute to the National goal and universal access to CT services. In addition to assisting CRS and PEPFAR to meet CT goals, CT has been shown to be an important component of Prevention of HIV infection. This project will strengthen testing services, and psychosocial and spiritual support services. 7D will continue to support post-test clubs at the parish level which will decrease stigma and discrimination experienced by PLWHA. In addition, it will feed into care and treatment services that further refer positive individuals to a set of comprehensive continuum of care and support services being provided by CRS and other PEPFAR Implementing Partners.

LINKS TO OTHER ACTIVITIES Very strong linkages exist between CT and CS (3.3.06), PMTCT (3.3.01), and AB (3.3.02). 7D aims to strengthen linkages between CT services and PMTCT, OVC specifically. Adults who test negative will be invited to become volunteers, or post-test club members. Youth testing negative will be invited to become active members of the Abstinence Diocesan Youth Groups, as well as referred to OVC (3.3.08) services. Adults testing positive will be referred to the following services: support group membership, post test club, care and support, PMTCT (for pregnant women), and ART. Youth testing positive are linked to pediatric ART (3.3.11 and 3.3.10) and OVC services.

POPULATIONS BEING TARGETED This activity will target the general population and people affected by HIV/AIDS (such as HIV/AIDS affected families, caregivers and widows). The 90 Parish communities with stand-alone CT centers target the general population which includes: adults, out-of-school youth, orphans and vulnerable children, and community workplaces. These CT centers are designed as places that would bring all members of the community together in order to provide services to and reduce HIV/AIDS-related stigma in communities.

KEY LEGISLATIVE ISSUES ADDRESSED Stigma and discrimination against PLWHA will be addressed through PACA and community mobilization. Post-test clubs will be designed to decrease stigma in the local communities. Issues of stigma and discrimination will also be addressed such as assisting in the provision of legal services to deal with inheritance issues.

EMPHASIS AREAS The Parish stand alone CT centers will primarily focus on development of network/linkages/referral systems, with the following minor focus areas, which include training community mobilization/participation and commodity procurement.

ACTIVITY DESCRIPTION SI activity relates to PMTCT (#6685), Abstinence and Be Faithful Prevention (#6684), Palliative Care: basic health care and support (#6686), and counseling and testing (#6687)

CRS Seven Dioceses 7D will provide SI activities to strengthen M&E in 11 states in Nigeria. Activities focusing on program level reporting, Health Management Information System (HMIS) and quality assurance will enhance reporting, monitoring, and management of ongoing HIV/AIDS related programs.

To ensure that high quality HIV/AIDS care is maintained, 7D will continue to strengthen HMIS by focusing on five activity areas: training to adapt existing paper records for PMTCT; palliative care activities and VCT to conform to the national system standards; work sessions to map out paper flow within clinical setting to ensure data flow and efficiency; provision of technical assistance to follow-up on paper flow and; quarterly site visits for review of the data management system to ensure efficiency and effectiveness. Focus will be on training PMTCT and palliative care site staff on GON paper records and standards, confidentiality, and adhering to standard protocols. SI funds will be used to ensure that project sites receive adequate on-going guidance and support from arch/diocesan and CRS staff. Tools will be modified as necessary to track the clients longitudinally in order to ensure a continuum of care.

Capacity of the diocesan partners will be built through centralized trainings (with the involvement of LGA representatives) and on-site technical assistance. Trainings will include how to use reporting forms, monitoring of paper flow, maintain clients' records, ensuring data accuracy and using data to track program progress and report writing in the areas of PMTCT, CS and VCT. Regular site visits and reviews will also be conducted to ensure data quality validation.

An M&E Specialist has been hired and will provide technical support and training to partners on how to collect, analyze and interpret their data. With technical support, partners will develop the capacity to evaluate their data and use the information to influence programming and improve performance. Regular program information sharing and interaction with partners will also be conducted to enhance their capacity for M & E. Standard protocols for service provision will continue to be reinforced. Ultimately, SI activities will result in development of partners' capacities to identify problems and find solutions locally which are necessary for program sustainability.

Although 7D is currently using a unique ID system, it will liaise with national working groups on PMTCT, VCT and palliative care in order to keep up to date with the latest GON plans. The aim is for 7D to be in full compliance with GON unique ID protocols in COP07.

A total of 10 Arch/dioceses, the CSN and 12 PMTCT facilities within 11 states will participate in SI activities while 23 sites will be supported and 46 individuals will be trained on SI. There is no geographical expansion in COP07 but services will be expanded within the same states as COP06.

CONTRIBUTIONS TO OVERALL PROGRAM AREA Improvement in SI management capacity of existing and new partners will ensure effective data use and management. This will contribute towards the GON and USG strategy for the provision of quality and timely information for decision making. It will also serve as a valuable resource in developing corrective action plans that would enhance the efficiency and effectiveness of operations and management of the 7D project. By strengthening the capacity of local partners, SI activities will further increase the sustainability of HIV/AIDS programs in Nigeria.

LINKS TO OTHER ACTIVITIES SI activity relates to PMTCT (#6685) Abstinence and Be Faithful Prevention (#6684), Palliative Care: Basic Health Care and Support (#6686), and Counseling and Testing (#6687). In addition, the links with the GON and other USG IPs will be strengthened.

POPULATIONS BEING TARGETED SI activities will target public health care workers, community-based organizations, and

faith based organizations.

KEY LEGISLATIVE ISSUES ADDRESSED SI activity provides program and QA/QC staff the opportunity to analyze data and identify key areas that may require improvement or legislative changes such as gender imbalance and ways it may be corrected.

EMPHASIS AREAS Major emphasis shall be on health management information system while other areas of emphasis will include: training: quality assurance, quality improvement, supportive supervision, monitoring & evaluation and reporting.