Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4167
Country/Region: Nigeria
Year: 2007
Main Partner: FHI 360
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $54,809,545

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $3,635,000

ACTIVITY DESCRIPTION: Prevention of mother to child transmission (PMTCT) services will continue to be integrated into Antenatal Care (ANC) as an entry point to HIV/AIDS prevention, care and support services for mothers, their infants, family members and the community. The landmark change in program strategies for COP 07 will be the establishment of integrated PMTCT services at primary health care (PHC) level in line with the minimum package stipulated by the Government of Nigeria (GON). GHAIN will lay emphasis on strategic prevention activities in PMTCT through the family centered approach utilizing lessons learned from Lagos and Kano model sites. This approach will promote options such as partner notification and testing, treatment support, infant feeding options, early infant diagnosis and integration of reproductive health/family planning initiatives in PMTCT.

Project activities will be tailored towards improving quality and use of maternal and child health (MCH) facilities, sensitizing and mobilizing communities to create demand for PMTCT services; ensuring that Counseling and Testing (C&T) is offered to all women presenting in antenatal clinic and in labor & delivery wards, with options to "opt out;" encouraging male involvement; and ensuring that antiretroviral (ARV) drugs are offered to HIV + pregnant women for PMTCT prophylaxis and/or for their own health, utilizing the national guideline as basis for treatment decisions. Those who test negative to HIV will receive post test counseling on how to remain negative. All clients who are tested will receive results on the same day. The funding will also address capacity building of health care workers on early diagnosis, counseling and support to families on infant feeding options in accordance with the national guideline on infant feeding. Services will also be geared towards ensuring that in labor & delivery rooms, safe obstetrical practices are implemented. Infants of a positive parent will be given cotrimoxazole prophylaxis from 6 weeks after birth, until their status is determined.

Based on the GHAIN ‘direct' activity to adapt the PMTCT training curriculum to PHC and train at 56 GHAIN supported PHC facilities, the GON will use this product to train 340 GON PHC sites at 4 staff per site (thus the values for indicator 1 and 4). Then an average of 240 ANC attendees will be reached by each GON PHC site per year, 216 with CT and results, 11 HIV+, 8 needing prophylaxis and 3 needing antiretroviral therapy (ART) - thus values for indicators 2 and 3. These will serve as indirect targets for GHAIN.

GHAIN has repositioned its strategies to partner with UNICEF in training additional 300 health care workers (HCWs) to provide PMTCT services to 60,000 clients in COP 07, with 3,000 receiving ARV prophylaxis. This will be achieved through the funding support to the existing 37 PMTCT sites and expand to 15 new antiretroviral therapy (ART) comprehensive and primary health care (PHC) facilities. GHAIN will also continue to provide PMTCT services in all its current six (6) focus states (FCT, Anambra, Kano, Cross River, Edo and Lagos States) and expand services to Niger, Enugu, Kogi, Taraba, Adamawa and Akwa Ibom States. GHAIN will support the establishment of a pilot/model comprehensive HIV/AIDS service in a rural Local Government Area of Cross River State. GHAIN will also strengthen the national paediatric program through a mentorship program in collaboration with the Clinton Foundation. GHAIN will also establish linkages with sites that have the necessary technology to obtain polymerase chain reaction (PCR) laboratory services for fees; utilizing dried blood spots (DBS) for expansion of infant diagnosis to all its prevention of mother to child transmission (PMTCT) supported sites.

Funding for Biomedical Prevention: Blood Safety (HMBL): $0

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

ACTIVITY DESCRIPTION This activity also relates to activities in Counselling and Testing (6702), Medical Transmission Injection Safety (3.3.04), Laboratory Infrastructure (6709).

GHAIN blood safety activities will ensure that all blood transfused in GHAIN supported clinical settings is HIV free. This will be accomplished with the provision of necessary training and equipment to screen all units of blood collected for transfusion in clinical facilities transfusing blood..

Capacity development for blood safety will include both personnel and institutional capacity building to improve the quality of blood safety services at clinical sites where blood is being transfused. Personnel capacity development will involve trainings in universal precautions, good laboratory practice, laboratory safety, use of rapid HIV test kits, and recording and reporting results. The institutional capacity development component will 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.

Using the GoN National training guideline, and the curriculum for HIV testing for blood transfusion safety, GHAIN will conduct a central TOT for two (2) senior laboratorians from each supported site. These two senior laboratorians will in turn train all the laboratory officers in their site, including all laboratory staff that handle blood for transfusion. The site trainings will be conducted under the supervision of the GHAIN laboratory staff. This training will also promote the principles of Universal Safety Precautions, reduction of unnecessary transfusions, dangers related to exposure to blood.

Essential consumables that protect the health worker from exposure to blood will be provided throughout the clinical facility. These universal precaution materials include personal protective equipment such as gloves, goggles, and aprons. Other consumables requried for HIV testing, such as methylated-spirit, hypochlorite solutions, antibacterial soaps, centrifuge, thermometer, pipettes and rapid HIV test kits will be provided. 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 involve follow the national algorithm for blood screening for every unit of blood screened. Expectedly, a total number of 6,240 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, GHAIN 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 40 ART sites in 10 GHAIN focal states namely Anambra, FCT, Lagos, Kano, Edo, Cross River, Enugu, Niger, Akwa Ibom and Kogi; and train 80 individuals in counseling and testing, blood safety protocol, and provide HIV screening for an estimated 6,240 individuals.

CONTRIBUTIONS TO OVERALL PROGRAM AREA This program will contribute to the PEPFAR 5 year strategy of prevention of HIV/AIDS by ensuring that all blood transfused are HIV free and by encouraging practices that reduce risk of exposure associated with blood transfusions and blood handling activities.. This activity will also contribute towards strengthening institutional mechanisms for safe blood activities and accountability systems on the use of HIV test kits in the PEPFAR program.

LINKS TO OTHER ACTIVITIES This activity also relates to activities in HVCT - 3.3.09. Positive clients from emergency screening will be referred for ART services using GHAIN referral network system. SFBAF is tasked with the larger role of supporting the National transfusion service and developing a network of blood banks that will eventually provide safe blood throughout the project area. This task will take some time however, and the need to screen blood for emergency

transfusions will continue in the interim. The emergency screening services provided for under this activity is intended to fill this gap in the clinical facilities that are currently being supported.

GHAIN will collaborate with SBFAF and work with States Ministry of Health (SMoH) to develop these services so that more complete safe blood activities can be instituted and emergency screening can be phased out.

POPULATIONS BEING TARGETED This activity targets laboratory technicians, health workers, and blood donors, with the recipients of emergency blood transfusions being the primary beneficiaries

EMPHASIS AREAS Major emphasis will be placed on training and commodity procurement (test kits and laboratory consumables) to support emergency blood screening and minor emphasis on quality assurance/quality improvement.

Funding for Biomedical Prevention: Injection Safety (HMIN): $125,000

ACTIVITY DESCRIPTION: This activity is linked to Medical transmission/Blood Safety (#6710) Condom and other prevention (#6707), PMTCT (#6706), Counseling and Testing (#6702), and ARV services (#6703).

The Global HIV/AIDS Initiative Nigeria (GHAIN) will strategically expand injection safety and basic level compliance with the universal safety precautions in all its forty (40) selected health facilities based on funding realities. Sites to be supported will be chosen from its current focus states of Lagos, Anambra, Edo, Kano, Cross Rivers, and FCT; and new states of Kogi, Niger, Akwa Ibom and Enugu.

With technical assistance from The John Snow Inc./ Making Medical Injection Safer (JSI/MMIS) project, GHAIN will apply four major technical approaches of making injection safer to create an enabling environment for health workers to provide quality services to clients without fear of medical accidents and infections. The approaches will include training and capacity building, behavioral change communication (BCC)/advocacy, procurement and supply of safe injection equipments, and health care waste management.

GHAIN will participate in adapting the World Health Organization (WHO) training tools for making medical injection safer, which will be anchored by the JSI/MMIS project. GHAIN will further sponsor participants to the national Training of Trainers (TOT) workshop that will be organized by JSI/MMIS on making medical injection safer and another that will be co-organized between JSI/MMIS and the Federal Ministry of Environment on health care waste management. Trainees from these TOTs will cascade the trainings to all the selected sites implementing HIV/AIDS services. The step down trainings will be conducted both at the state and facility levels to ensure adequate coverage of sites and at least 300 participants will be trained. GHAIN will support JSI/MMIS and the ENHANSE project in their efforts towards ensuring behavior change of the communities through advocacy for policy change at the national level of government, while focusing on ensuring behavior change of the health workers and clients towards making medical injection safer in its supported health facilities. Behavior change communication (BCC) materials produced by JSI/MMIS on injection safety will be obtained and distributed to all GHAIN supported sites.

While depending on JSI/MMIS to make procurement and supplies of safe injection equipment to GHAIN supported sites, GHAIN will make further arrangements for other day-to-day consumables. GHAIN will advocate to the facilities to utilize the universal safety precautions in the disposal of medical wastes. Health workers will be encouraged to utilize the knowledge and skills gained from the universal safety precaution and waste management training to apply same to practice. In each selected facility for injection safety activities, GHAIN will focus on both health workers working on the project and those not directly working on the project.

CONTRIBUTION TO OVERALL PROGRAM AREA: Injection safety will contribute to the overall program by preventing nosocomial transmission of HIV and other blood borne pathogens. Such activities will also improve the safety of the Healthcare provider thus leading to reduction of stigma to clients and making the clients feel safe and access the health system for care and treatment of AIDS.

This will result in an increase in the uptake of Counseling and Testing (CT), Palliative Care (PC), Antiretroviral Therapy (ART), Prevention of Mother to Child Transmission (PMTCT) and laboratory services, leading towards target achievement in all areas.

LINKS TO OTHER ACTIVITIES: The GHAIN Injection safety program in the six focal states will relate to activities in Medical transmission/Blood Safety - 3.3.03, Condom and other preventive activities - 3.3.05, PMTCT - 3.3.01, Counseling and Testing - 3.3.09, and HIV/AIDS Treatment services - 3.3.11. The linkages of all the above components will ensure compliance with Centers for Disease Control (CDC) Universal Precautions and impact not only the quality of care given to clients but also care and safety of the health care worker.

POPULATIONS BEING TARGETED: GHAIN will provide injection safety trainings and service aids to health care workers such

as doctors, nurses, pharmacists, laboratory workers and waste handlers at the various points of service where sharps are used and these will include counseling and testing units, laboratory, phlebotomy rooms, wards, labor rooms, delivery rooms and immunization clinics among others. Education on proper handling and use of sharps, including disposal methods will be extended to health workers outside the HIV/AIDS services and to clients.

KEY LEGISLATIVE ISSUES ADDRESSED: Strengthening of injection safety procedures across the GHAIN supported facilities in the GHAIN focus states will go a long way in reducing HIV/AIDS related stigma and discrimination amongst healthcare workers. This attitude change will in turn create an enabling environment for clients to access HIV care and Treatment services.

EMPHASIS AREAS: This activity includes major emphasis on capacity building through the training of key health care and minor emphasis on procurement of injection safety equipment/consumables and distribution of BCC materials.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $2,290,000

ACTIVITY DESCRIPTION This activity also relates to activities in VCT (#6702), ARV services (#6703), PMTCT (#6702), Care and Support (#6708) and TB/HIV (#6700).

Global HIV/AIDS Initiative Nigeria (GHAIN) will provide condom and other prevention services to 146,250 most at risk populations (MARPS) by building upon activities of the twelve (12) existing sites in six (6) states of Lagos, Kano, Anambra, Edo, Cross Rivers and the Federal Capital Territory (FCT), while training 165 people and increasing coverage of each implementing agency by going to additional target Local Government Agencies (LGAs) within the same States

Condom and Other Prevention (C&OP) activities will focus on a range of prevention activities that address issues of stigma and discrimination, sexual transmission of HIV, and medical transmission of HIV as well as prevention of HIV within positive populations. Activities under the C&OP component will be directed towards road transport workers, commercial sex workers, People Living with HIV/AIDS (PLWHAs) and medical personnel, aimed at: eliminating or reducing risky behaviors; expanding access to clinical services for MARPS, including referral for diagnosis and treatment of sexually transmitted infections (STI); and linking PLWHA prevention services to HIV treatment and care services, including counseling and testing. In particular, small scale interventions will focus on men who have sex with men (MSM) in two states. Location of these interventions will be determined based on the results of the ongoing IBBS expected in August 2007.

Funding will be specifically directed at promotion of risk reduction behavior including partner reduction, mutual fidelity and, most especially, correct and consistent condom use. This will be carried out through community mobilization, production and distribution of strategic behavior change (SBC) materials, referral and linkages with other services such as diagnosis and treatment of sexually transmitted infections (STIs), counseling and testing, etc. Family Health International (FHI) and its partners will collaborate with the Society for Family Health (SFH) and United Nations Fund for Population Activities (UNFPA) to obtain and distribute condoms those most at risk of transmitting or becoming infected with HIV. The condom use programs will be tailored to promote the understanding that abstaining from sexual activity is the most effective and only certain way to avoid HIV infection; the importance of risk reduction and a consistent risk-reduction strategy when risk elimination is not practiced; the importance of correctly and consistently using condoms during every sexual encounter with partners known to be HIV-positive (discordant couples) or partners whose status is unknown; the critical role of HIV counseling and testing as a risk-reduction strategy; the development of skills for vulnerable persons; and the knowledge that condoms do not protect against all STIs.

In addition to activities described above, GHAIN will collaborate with the Positive Living project implemented by the Center for Education and Population Activities (CEDPA) to target PLWHA with prevention for positives activities during home visits, support group education sessions, adherence counseling sessions, etc. GHAIN will reach another wider population of about 70,000 people (as indirect targets) through multiplier effects of prevention messages and activities passed through peer educators and other SBC activities.

GHAIN will continue to strengthen the development of an exit/sustainability plan for all implementing agencies, both at the country and program levels, working with the implementing agencies (IAs) as a group to build capacity, and at the individual implementing agency level to customize a specific plan and schedule for each organization. The plans will include an assessment phase, a customized plan for building capacity, a set of clear objectives and indicators for measuring capacity, and a handover timeline based on key benchmarks.

CONTRIBUTIONS TO OVERALL PROGRAM AREA These condom and other prevention activities are consistent with PEPFAR 5 year strategy for Nigeria which seeks to scale up prevention services, build local capacity to respond to the HIV/AIDS epidemic, and avert new infections. GHAIN will contribute to the overall United States Government (USG) strategic plan of building the capacity of local organization by working with local non-governmental organizations (NGOs) to carry out C&OP activities with MARPs and related segments of the general population. GHAIN will

also focus on building the capacity of local implementing agencies to effectively carry out sustainable HIV prevention activities among MARPs, including development and dissemination of Information, Education and Communication (IEC) materials, community mobilization, condom use programs, peer education activities, counseling services, referrals and linkages among others. The C&OP activities will in turn contribute to generating demands for counseling and testing (CT) and prevention of mother to child transmission (PMTCT) services which serve as entry points for other services such as ART and palliative care. GHAIN will leverage child survival/population funds to integrate appropriate reproductive health messages into the C&OP programs for the uniformed services and their dependants.

LINKS TO OTHER ACTIVITIES This activity also relates to activities in VCT (#6702), ARV services (#6703), PMTCT (#6702), Care and Support (#6708) and TB/HIV (#6700). The mobile counseling and testing team of GHAIN will strategically locate and provide services at areas identified that have concentrations of MARPS. People who test positive will be referred for continued care along the continuum of care network model. The referral coordinators of GHAIN will assure referrals to continued counseling, palliative care, tuberculosis (TB) screening and ART services (if eligible). GHAIN will ensure high quality C&OP data through a sound information system that precludes double counting and ensures accountability.

POPULATIONS BEING TARGETED Targets for this activity will include road transport workers, commercial sex workers (CSW), discordant couples, PLWHAs, mobile populations, truck drivers, medical personnel (public and private health care workers), clients/partners of CSW, and out of school youths.

KEY LEGISLATIVE ISSUES ADDRESSED This activity will take into consideration gender issues related to HIV/AIDS programs through providing equal quality prevention services without discrimination against sex, nationality, religion, creed, etc. The activity will help address male norms and behaviors while reducing violence and coercion toward females through vigorous campaigns to educate people on the benefits of couple counseling and testing (CT) and mutual disclosure of HIV status. The greatly increased availability of Mobile CT in rural areas will also help reduce Stigma and Discrimination against people who test positive to HIV.

EMPHASIS AREAS This activity includes a major emphasis on Community Mobilization/Participation and a minor emphasis on Training, IEC and Local Organizational Capacity Development.

Funding for Care: Adult Care and Support (HBHC): $3,013,750

ACTIVITY DESCRIPTION The GHAIN PC in the focal states relates to activities in GHAIN 3.3.10 (6705), 3.3.07 (6700), 3.3.08 (6701) and 3.3.01(6706).

Global HIV/AIDS Initiative Nigeria (GHAIN) will provide facility-based palliative care (PC) services to 52,503 people living with HIV/AIDS (PLWHAs) by supporting 28 existing comprehensive antiretroviral therapy (ART) sites, establishing 12 new sites and increasing coverage by going to four additional focus states listed among the USG priority states.

In Country Operational Plan 07 (COP07), GHAIN will support practical strategies that ensure people living with HIV (PLHIV) can access comprehensive and qualitative, non-ART, basic HIV/AIDS care and support. Based on lessons learned, funding priorities and the present partner guidance, GHAIN will focus on facility-based approach to PC service delivery while the Centre for Development and Population Activities (CEDPA), a USG partner implementing community home based care (CHBC), becomes responsible for the community-based components of care.

GHAIN will strategically engage all the comprehensive ART sites and the selected Primary Health Care (PHC) centers to provide comprehensive basic care and support services in line with the National Palliative Care Guidance and the USG PC Policy. Services to be provided include: HIV counseling and testing (CT) that will be supported under the CT program; basic nursing care, assessment of signs and symptoms (including pain), prevention of malaria and opportunistic infections (OIs), PC medications, nutritional assessment; psychological care including adherence counseling, pain control; non-ART laboratory services; referral support for ART and other medications. GHAIN will establish strong linkages with CEDPA, to provide the Home Based Care (HBC) and other support services for all its clients. GHAIN will work with CEDPA, other United States Government (USG) implementing partners and Government of Nigeria (GON) to finalize the development of the training manual on facility palliative care and home based care for providers and volunteers. GHAIN will also develop a standardized training manual for integrating HIV services into PHCs. These manuals will be produced for utilization by the GON and USG service providers and volunteers in PC points of service. A total of 200 people will be directly trained by GHAIN using these materials, in addition to numerous other indirectly throughout the country.

GHAIN will strengthen support groups, integrated into forty (40) comprehensive ART sites and in PHCs in saturation states, namely Anambra, Edo, Federal Capital Territory (FCT), Lagos, Cross River, Kano, Akwa Ibom, Enugu, Kogi and Niger states. The activities of the support groups to be funded by GHAIN will be mainly for contact tracking and peer support, while CEDPA provides continued community- and home-based care services, thus, ensuring a working continuum of care without duplication of services.

Howard University will continue to work with the Pharmaceutical Society of Nigeria (PSN), other pharmacy professional bodies and where possible, help licensed patent medicine vendors to build the capacity of their members in seven pilot communities to further improve the dispensing of prescribed PC related medications through PHC facilities and patent medicine stores as applicable, as well as to complement the existing referral services for clients. Additionally, Howard will be a part of the close collaboration with CEDPA and will offer training-of-trainers workshops to their community health extension workers on aspects of medication-related PC.

CONTRIBUTIONS TO OVERALL PROGRAM AREA This project will contribute to reaching 52,503 PLWHA out of the USG overall strategic five year plan for Nigeria. It will also contribute to strengthening the national, state and local/facility level systems for implementing quality PC programs. The diagnostic laboratory services will be used for monitoring PLHIV thus ensuring timely entry into the ART program.

This program will also contribute to institutional and staff capacity building. Thus, GHAIN will continue to strengthen its exit/sustainability plan both at the country program level working with the health facilities implementing comprehensive ART programs and at the local level working with the facility based support groups to build their capacity and to customize a specific plan and schedule for each facility. The plans will include an

assessment phase, customized plan for building capacity, and a set of clear objectives and indicators for measuring capacity as well as a time line based on key benchmarks.

LINKS TO OTHER ACTIVITIES GHAIN will concentrate its PC activities in the health facility while CEDPA concentrates on community- and home-based care services. The facilities will identify one staff that will serve as a PC coordinator and will be provided with necessary training to double as the supervisor for all PC activities, including the facility based support groups. The facility referral coordinator and the PC coordinator will work hand in hand to coordinate the linkages between CEDPA and GHAIN supported activities. These will provide linkages to care and support services for those persons who test positive for HIV (including pregnant women). They will also ensure management for OIs and the all-important contact tracking for clients on ARV drugs that are lost to follow-up. These linkages will assist in maximizing the support opportunities provided by PEPFAR funding. GHAIN will also work in lose collaboration with the National Public Health directorate to strengthen delivery and decentralization of HIV management to PHC. GHAIN will work closely with the GON in the development of the National HBC manuals, as well cross referrals within public facilities for PC related complications.

POPULATIONS BEING TARGETED GHAIN will provide PC services (specifically clinical care and support services) to adults (including pregnant women) living with HIV/AIDS through facility-based support groups. These clients will be generated from PMTCT, Care and Treatment, counseling and testing, and TB-HIV programs. GHAIN will empower secondary and primary health care facilities to serve as referral points for clients and their families being provided with HBC services by CEDPA.

KEY LEGISLATIVE ISSUES ADDRESSED GHAIN will strengthen gender equity in HIV/AIDS care and support programs while emphasizing male involvement in care initiatives to ensure sustainability. GHAIN will collaborate with Partners for Development to provide micro-credit facilities for indigent clients, and with other USG implementing partners to provide wrap around services that protect the rights of the child, enhance food supply, improve sanitation in communities, provide clean water and Insecticide Treated Nets (ITN) and strengthen non-HIV health services, including family planning, child health and nutrition.

EMPHASIS AREAS This activity includes a major emphasis on capacity building through the training of key health care providers which is critical in delivery of quality laboratory and clinical palliative care services to clients. Minor emphasis will lie in the development and strengthening of referrals/linkages and on commodity procurement.

With plus up funds GHAIN will: expand into two additional states with three comprehensive sites; pilot LGA comprehensive services with palliative care in five primary health clinics and three home-based care service outlets; and, train 72 additional service providers and serve 7,000 PLWHAs.

Funding for Care: TB/HIV (HVTB): $2,283,000

ACTIVITY DESCRIPTION: The goal of the tuberculosis (TB) component is to reduce the burden of TB and HIV-related TB by expanding joint TB/HIV activities, expanding Directly Observed Treatment services (DOTS) coverage and increasing community participation in TB/HIV activities. Global HIV/AIDS Initiative Nigeria (GHAIN) will implement this activity in close collaboration with the National Tuberculosis and Leprosy Control Program (NTBLCP) and other partners based on the following guiding principles: services will be enhanced and expanded to ensure that all TB patients have access to HIV diagnosis and care services, and all HIV patients have access to TB care and services; implementation of joint TB/HIV activities (including supervision) will be in-line with national policies and guidelines; involvement of people living with HIV/AIDS (PLWHA), tuberculosis (TB) patients, and communities in TB/HIV program planning and implementation, and proper mechanisms for preventing cross infection or re-infection of TB in the health facilities.

Strengthening of the TB/HIV services will involve the expansion of service delivery points to include Primary Health Care (PHC) levels and the intensification of case finding, case holding and referrals. This will include the introduction of TB control activities into HIV service points through: promotion of community mobilization and TB education including treatment adherence and stigma reduction where HIV services are provided; introduction of sputum smear microscopy and TB treatment in CT centers; training of HIV/AIDS support groups and community-based organizations (CBOs) on TB control activities; and strengthening TB care delivery (treatment & monitoring) by HIV home-based or CBOs. Similarly, TB/HIV services will be strengthened by establishment or integration of HIV services into TB clinics via the following activities: provision of HIV education at TB service points; promotion & provision of HIV counseling & testing (CT) to TB patients; active case finding of TB cases among household of HIV-infected patients; establishment of an effective referral mechanism for management of HIV-related illnesses; and training of health care workers in the management of drug side effects and immune-reconstitution syndrome. While GHAIN will concentrate its services within the health facilities, the Center for Development and Population Activities (CEDPA) will support GHAIN's initiatives by providing community and home based care for HIV positive clients who are also sputum smear positive.

GHAIN, through German Leprosy and TB Relief Association (GLRA), is actively involved in the National efforts for TB. GLRA is one of the key partners in the design/implementation/update of the National reference tools (Standard Operating Procedures (SOPs), checklist). All National TB accomplishments can be claimed as indirect targets, and we estimate that aside of GHAIN's direct accomplishments, 300 centers will provide TB treatment to 15,000 HIV infected patients. GHAIN will also put systems in place to track the United State Government (USG)/Nigeria custom indicators for TB/HIV services.

GHAIN will provide TB/HIV services in comprehensive sites and PHCs in Anambra, Edo, FCT, Lagos, Cross River and Kano States and eight new states, namely Akwa Ibom, Kogi, Enugu, Taraba, Adamawa, Bauchi, Benue and Niger States. Depending on performance of GFATM, this expansion plan may need to be revised. GHAIN will support the establishment of a pilot/model comprehensive HIV/AIDS service in a rural Local Government Area (LGA) of Cross River State and an urban LGA in Kano State. A total of 4,608 HIV-infected clients attending HIV care/treatment services will receive treatment for TB disease. GHAIN will train 347 health workers in TB/HIV screening and diagnosis (emphasizing TB in HIV infected clients).

Funding for Care: Orphans and Vulnerable Children (HKID): $1,115,000

Reprogramming 9/07: CEDPA will provide non-clinical services for each OVC supported by GHAIN in those communities where the two projects are active. The targets will be attributed to GHAIN, but the activity narratives will reflect that 2050 OVC will received $100 each of community oriented supports through CEDPA's activities.

ACTIVITY DESCRIPTION This activity relates to activities in HTXD (6705), HVTB (6700), HBHC (6708) and MTCT (6706).

Global HIV/AIDS Initiative Nigeria (GHAIN) will provide palliative care (PC) services to 3,681 children living with HIV (CLHIV) by supporting 75 sites (new and old) and increasing coverage by going to 8 additional focus states listed among the USG priority states.

In COP07, GHAIN will support practical strategies that ensure CLHIV can access comprehensive and qualitative, non-ART, basic HIV/AIDS care and support. Based on lessons learnt, funding priorities and the present partner guidance, GHAIN will focus on facility based approach to PC service delivery while the Centre for Development and Population Activities (CEDPA) - a USG partner implementing community home based care (CHBC) - becomes responsible for the community-based components for care.

GHAIN will strategically engage all the comprehensive ART sites and the selected Primary Health Care (PHC) centres to provide comprehensive basic care and support services in line with the National Palliative Care Guidance and the USG PC Policy. Services to be provided include: HIV counseling and testing (CT) that will be supported under the CT program; basic nursing care, assessment of signs and symptoms (including pain), prevention of malaria and opportunistic infections (OIs), PC medications, nutritional assessment; psychological care including adherence counseling for children and their care givers, pain control; non-ART laboratory services; referral support for ART and other medications. GHAIN will establish strong linkages with CEDPA, to provide the Home Based Care (HBC) and other support services for all its clients. GHAIN will work with CEDPA, other USG partners and Government of Nigeria (GON) to finalize the development of the training manual on facility palliative care and home based care for providers and volunteers. GHAIN will also develop a standardized training manual for integrating HIV services into PHCs. These manuals will be produced for utilization by the GON and USG service providers and volunteers in PC points of service. A total of 300 people trained to provide PC for both children and adults will serve the children population.

GHAIN will further establish a pilot Early Infant Diagnosis (EID) laboratory in Cross River State to support the State's strategy of universal access. It is envisioned that this laboratory will serve as a reference laboratory serving the 5 comprehensive sites in Cross River, as well as sites located in Anambra, Akwa Ibom, Rivers and Edo.

GHAIN will strengthen support groups, integrated into 45 comprehensive ART sites and in 30 PHCs in saturation states, namely Anambra, Edo, FCT, Lagos, Cross River and Kano states and expand into eight new states, namely Akwa Ibom, Kogi, Enugu, Taraba, Adamawa, Bauchi, Benue and Niger States. Depending on performance of GFATM, this expansion plan may need to be revised.

The activities of the support groups to be funded by GHAIN will be mainly for contact tracking of children and support to their care givers, while CEDPA provides continued community home based care services, thus, ensuring a working continuum of care without duplication of services.

GHAIN is a major player in the design of the National reference tools for PC/HBC (curricula, SOP…). At least 30 PHC and 45 ART centers (total: 75) will use these tools. Next to 4 staff per center will be trained, thus, 300 persons trained. At least 25,000 children on ART in the country will benefit from this tool, as well as the CLWHA registered but not yet on treatment. These will serve as indirect targets.

Howard University will continue to work with the Pharmaceutical Society of Nigeria (PSN), other pharmacy professional bodies and where possible, help licensed patent medicine vendors to build the capacity of their members in seven pilot communities to further improve the dispensing of prescribed PC related medications through PHC facilities and

patent medicine stores as applicable, as well as complement the existing referral services for clients. Additionally, Howard will be a part of the close collaboration with CEDPA and will offer training-of-trainers workshops to their community health extension workers on aspects of medication-related PC.

CONTRIBUTIONS TO OVERALL PROGRAM AREA This project will contribute towards reaching 3,144 CLHIV out of the USG overall strategic five year plan for Nigeria. It will also contribute to strengthening the national, state and local/facility level systems for implementing quality PC&S programs. The diagnostic laboratory services will be used for monitoring CLHIV thus ensuring timely entry into the pediatric ART program.

This program will also contribute to institutional and staff capacity building. Thus, GHAIN will continue to strengthen its exit/sustainability plan both at the country program level showing how it will work with the health facilities implementing comprehensive ART programs and the facility based support groups, to build their capacity and to customize a specific plan and schedule for each facility. The plans will include an assessment phase, customized plan for building capacity, and a set of clear objectives and indicators for measuring capacity as well as a time line based on key benchmarks.

LINKS TO OTHER ACTIVITIES GHAIN will concentrate its PC activities in the health facility, providing medical care services while CEDPA takes the community home based care services, to provide social support, spiritual care, psychosocial care and procurement of kits. The facilities will identify one staff that will serve as a PC coordinator and will be provided with necessary training to double as the supervisor for all OVC PC activities, including the facility based support groups to ensure that the needs of children and their care givers are catered for. The facility referral coordinator and the PC coordinator will work hand in hand to coordinate the linkages between CEDPA and GHAIN supported activities. These will act as linkage for those children who test positive to HIV to care and support services as well as providing management for OIs and for contact tracking children on (antiretroviral) ARV drugs who are lost to follow-up. These linkages will assist in maximizing the support opportunities provided by the Emergency Plan's funding.

POPULATIONS BEING TARGETED GHAIN will provide PC services (specifically clinical care and support services) to children living with HIV/AIDS through facility-based support groups. The children will be generated from Care and Treatment, counseling and testing, and TB-HIV programs. GHAIN will empower secondary and primary health care facilities to serve as referral points for children and their families being provided with HBC services by CEDPA.

KEY LEGISLATIVE ISSUES ADDRESSED GHAIN will strengthen gender equity in HIV/AIDS care and support programs using a comprehensive approach; addressing the specific needs of children in this regard and also emphasizing male involvement in care initiatives to ensure sustainability. GHAIN will collaborate with the Partners for Development to source for micro-credit facilities for the indigent care givers to be able to support the children, and with other USG implementing partners to wrap around good governance by securing services that protect the rights of the child, enhance food supply, improve sanitation in communities, provide clean water, Insecticide Treated Nets (ITN) and strengthen non-HIV health services, including child health and nutrition.

Funding for Testing: HIV Testing and Counseling (HVCT): $4,307,795

ACTIVITY DESCRIPTION: The Global HIV/AIDS Initiative Nigeria (GHAIN) will provide counselling and testing (CT) services to 279,939 individuals by supporting 79 existing CT sites branded as Heart-2-Heart (H2H) centres and will increase coverage of the mobile voluntary counselling and testing (VCT) services in under-served rural communities of the eight new states, namely Akwa Ibom, Kogi, Enugu, Taraba, Adamawa, Bauchi, Benue and Niger States. CT sites and Mobile CT will be strategically located and may be expanded to provide adequate coverage of catchments areas and access to clients that will be fed into the GHAIN, AIDSRelief and Havard University supported comprehensive antiretroviral therapy (ART) services. The addition of two mobile sites is envisioned.

Following a cluster model, two CT sites will be established or strengthened wherever GHAIN or GFATM/FHI- supported comprehensive ART sites are located. In addition, GHAIN will support the establishment of a pilot/model comprehensive HIV/AIDS service in a rural Local Government Area of Cross River State and an urban LGA in Kano State.

GHAIN will provide integrated CT services including diagnostic CT in the wards and the out-patients departments (OPD); routine (opt-out approach) CT at antenatal (ANC), tuberculosis (TB), family planning (FP) and sexually transmitted infection (STI) clinics, in order to increase uptake of services and provide an opportunity for those who require care, treatment and support services to access them.

VCT services will also be located within the same health facilities for self-referrals, including community outreach services. GHAIN will adopt the national approved non-cold chain dependent HIV test algorithm as contained in the national CT guidelines. This will assist in the expansion of CT services to rural areas and the use of lay counsellors to conduct HIV testing. To ensure quality of CT services especially testing, 10% of positive samples and 5% of negative samples will be sent to an identified laboratory for external quality assurance. GHAIN will continue to support the Nursing and Midwifery Council of Nigeria to train care providers as counsellors and testers to provide services, using the national CT training curriculum. Trainings will include training of trainers and step down for a total of 100 persons on couple counselling and testing.

GHAIN will also provide mobile CT services to address the health needs of most-at-risk-populations (MARPS) such as Long Distance Drivers (LDD), commercial sex workers and armed forces personnel. Mobile VCT services will also be extended to the youths; as well as churches, mosques and market places, women/men's groups. Emphasis will be laid on partner notification and disclosure of test results as well as pre and post-test counseling opportunity for both positive and negative clients.

This funding will go specifically towards assessments, refurbishment/renovation, procurement of reagents and materials, capacity building of counselors/testers, and training of supervisors to ensure adequate quality of services and commodity management. Rapid test kits will be centrally procured and stored in a central warehouse that will be hired by Axios/GHAIN. Axios/GHAIN will also be responsible for distribution of test kits to sites, ensuring good storage at the site levels and train site staff on Logistic Management Information System (LMIS) and Inventory Control Systems (ICS). GHAIN will continue to support and participate in the harmonization process led by the Government of Nigeria (GON) with regard to LMIS and ICS for test kits. GHAIN will establish one model site in each state to serve as examples for replication. GHAIN will ensure high quality CT data collection and collation using the National VCT-monitoring and evaluation (M&E) system GHAIN is designing for the government of Nigeria (GoN).

In COP06, GHAIN supported CT services in over 100 points of service in addition to mobile CT services across the 6 focus states. Significant changes from COP 06 for this activity will include the close-out of some stand-alone CT sites as they are handed overt to the GFATM and intensification of mobile CT services across the focus states. Discussions have already commenced with the various State governments regarding the modalities for handover of the sites to the host governments for continued management and sustainability under the GFATM.

CONTRIBUTION TO PROGRAM AREA GHAIN will continue to provide CT services in the current 6 focus states and 4 additional states, contributing up to 219,298 of COP 07 overall emergency plan CT targets for

Nigeria. The aim of the program will be to reach as many people as possible in order to curb the epidemic and improve the health of populations within each state. Planned Mobile CT services will improve equity in access to HIV prevention and care services since the currently underserved rural communities will have better access, and GHAIN will work to ensure there are adequate networks and linkages between these rural VCT sites and medical sites where AIDS care and treatment are available. Overall, these activities contribute to the Emergency Plan's goal of providing HIV care to more than 1,500,000 persons while preventing 800,000 new infections by 2009.

LINKS TO OTHER ACTIVITIES Linkages will be strengthened between the various components listed above to provide total care to individuals who test positive to HIV and to make referrals to AIDSRelief and Harvard supported services. GHAIN has developed a referral directory of all care and support services in the focus states and identified referral focal persons to ensure an active referral system. GHAIN will also take the lead in the setting-up the CT network in the focal states, in collaboration with USG Nigeria and the GON. GHAIN will continue to obtain condoms from the Society for Family Health and offer them free of charge after condom education to each client attending CT services. Linkages will also be strengthened with care and support and orphans and vulnerable children activities in the focus communities.

GHAIN will continue to strengthen its exit/sustainability plan both at the country and project level. It will work with the health facilities implementing comprehensive CT programs to build their capacity and to customize a specific plan and handover schedule for each facility.

TARGET POPULATIONS CT services will target the general population as well as most-at-risk populations (MARPs) such as uniformed services, people in workplaces/business/private sector, and family members of index clients, especially discordant couples for support. Other target audiences for these services will include adult males and females, out-of-school youth (males and females), street youth, pregnant women and TB patients.. The Heart-to-Heart centers and, especially the mobile teams will provide services in high traffic settings (i.e., motor parks, market places, churches, mosques), and army and police barracks in the focus States, in collaboration with the Armed Forces Program on AIDS Control (AFPAC) and the Police HIV/AIDS Control Committee (PACC).

LEGISLATIVE ISSUES This activity will address gender equity in HIV/AIDS programming through counseling messages targeted to vulnerable young girls and women. This activity will also deal with male norms and behaviors through vigorous campaigns to educate people of the focus states on the benefits of couple CT and mutual disclosure of HIV status. The much increased availability of CT services in clinical and hospital ward settings will also help to reduce stigma and discrimination.

EMPHASIS AREAS There is major emphasis on human resources and minor emphasis on infrastructure; local organization capacity development; quality assurance and trainings.

Funding for Treatment: ARV Drugs (HTXD): $15,540,370

ACTIVITY DESCRIPTION This activity has several components namely: forecasting and procurement, inventory management, warehousing and quality delivery of antiretroviral (ARV) drugs to people living with HIV/AIDS (PLWHA) for antiretroviral therapy (ART). Global HIV/AIDS Initiative Nigeria (GHAIN), through its sub-recipient, the Axios Foundation emphasizes the following core project areas: capacity building and systems strengthening, forecasting for ARVs and opportunistic infections (OIs), procurement, port clearance, warehousing, and distribution of ARVs and related commodities to facilities under the project. Axios has developed a functional logistics system to ensure consistent availability of secure and high quality ARVs and related commodities plus accountability for the deliveries/usage. The process is guided by USG regulations, National Treatment Guidelines, National Agency for Food and Drug Control (NAFDAC) registration or waivers with a view towards utilizing generic ARV's once the United States Food and Drug Administration (FDA) approved.

Axios has implemented an Inventory Management System to track logistics data needed for the proper management of ARV drugs. The system also has the Patient Management and Monitoring (PMM) System. In COP06, all facilities managed their ARVs and related commodities using the system; including generation of management reports required for decision making at facility and Axios/GHAIN levels. Guided by the memorandum of understanding with the Federal Ministry of health (FMOH) and States Central Medical Stores (SCMS), Axios will continue to build capacity for warehousing and distribution by developing standard operating procedures (SOPs) for warehousing and distribution at the central medical stores. It will build capacity of the government of Nigeria (GON) and Axios staff at the SCMS through training and on the job mentoring on the core project areas mentioned above. All commodities procured are stored at the central medical stores from where they are distributed to facilities via the state program office. Axios will work with the GON and the medical stores to ensure adequate security of drugs supplied.

In COP07, the strategy will focus more on the State Ministry of Health (SMOH) owned Central Medical Stores and utilize their linkages to the ART facilities to serve the needs of the focus states and build partnership with private/non for profit sector by sub-contracting warehousing and distribution services at state government level. Quality assurance and monitoring of the logistics system will continue to be maintained at all levels The SOPs and forms currently used will be revised based on GON led harmonization process in which Axios is actively involved. The long term plan is to coordinate the distribution and utilization of the GON drugs and the project drugs based on availability.

Axios/GHAIN will continue to strengthen sustainability plans by harmonizing drug logistic systems with the GON and providing technical assistance and training in forecasting, inventory management and reporting for pharmacists through on-site training and mentoring. GHAIN will provide ART services to a cumulative number of 34,293 including 19,253 new PLWHAs by supporting 28 existing ART sites, establishing 17 new sites and increasing geographical coverage with focus on rural areas from the current six states (FCT, Anambra, Lagos, Kano, Cross River and Edo states) to eight new states, namely Akwa Ibom, Kogi, Enugu, Taraba, Adamawa, Bauchi, Benue and Niger States. Depending on performance of GFATM, this expansion plan may need to be revised. GHAIN will support the establishment of a pilot/model comprehensive HIV/AIDS service in a rural Local Government Area of Cross River State. GHAIN will also strengthen the national paediatric program through a mentorship program in collaboration with the Clinton Foundation. The new sites will be assessed using the site assessment tool and implementation will be based on the minimum start up requirements of the site. Specific attention will be paid to ensuring security of drugs as a component of new sites assessment and its implementation or strengthening.

Negotiations are currently underway with the GON to leverage Global Fund resources to provide a dramatic increase in numbers that will be provided with ART services. Should these negotiations prove successful, GHAIN would initiate ART services in additional sites to expand patient targets. According to this strategy, after services have been initiated, and providers are well trained and systems are in place, the sites will be handed over to the GON for continued support with Global Fund resources. This will in turn allow GHAIN to initiate another set of new sites without having to bear ongoing maintenance costs. Technical assistance, monitoring and evaluation, and supportive supervision will continue in all sites throughout the life of the project and will ensure strong capacity-building,

powerful ownership, and guaranteed sustainability.

CONTRIBUTIONS TO OVERALL PROGRAM AREA: Commodity availability at facility level is the cornerstone of the strategy to increase access to the drugs and diagnostics for PLWHA and significantly contributes to the achievement of the Emergency Plan's goals. The provision of ART services through this program will contribute to strengthening and expanding the capacity of the Government of Nigeria's response to the HIV/AIDS epidemic and increasing the prospects of meeting the Emergency Plan's goal of providing life-saving antiretroviral treatment to more than 350,000 individuals. This program will also contribute to strengthening the national drug/commodity logistics and management systems, especially as it relates to ARVs and test kits among others.

LINKS TO OTHER ACTIVITIES: This program element relates to activities in HVCT-3.3.09, MTCT -3.3.01 HTXS- 3.3.11, HBHC- 3.3.06 and HLAB - 3.3.12. Links to these programs include covering areas such as logistics and management of test kits (HVCT), ARV drugs (HTXS) for adults and children, OIs drugs (HBHC), prophylactic ARV drugs for pregnant women and infants (PMTCT) as well as the provision of laboratory supplies for patient monitoring (HLAB).

POPULATIONS BEING TARGETED: This activity targets all health care workers directly involved in the management of ARV drugs for ART services including pharmacists, doctor and nurses.

KEY LEGISLATIVE ISSUES ADDRESSED: None

EMPHASIS AREAS: Axios major emphasis areas for COP07 will include commodity procurement while minor emphasis will be on logistics, local organization capacity development, training and quality assurance, quality improvement and supportive supervision.

Funding for Treatment: Adult Treatment (HTXS): $15,540,370

ACTIVITY DESCRIPTION With support from the Emergency Plan through United States Agency for International Development (USAID)/Nigeria, The Global HIV/AIDS Initiative Nigeria (GHAIN) has provided antiretroviral therapy (ART) services to over 14,000 PLWHAs in six (6) states of Nigeria, through working with the Government of Nigeria (GON) and Faith Based Organizations (FBOs).

In COP 07, GHAIN will continue to provide HIV comprehensive care and treatment (ART services) within secondary facilities and expand services to the primary healthcare facilities while strengthening linkages to tertiary facilities to provide a complete network of care and treatment services. This activity will concentrate on the development and implementation of quality package of services and standards of care that are consistent with the national guidelines on ART, integration of prevention into care and treatment programs, promotion of adherence and comprehensive care including clinical monitoring and management of opportunistic infections with related laboratory services, as will be described under palliative care. GHAIN will build upon the lessons learned from implementing ART services in primary health care centers (PHCs) to continue to train community health officers (CHOs), community health extension workers (CHEWs) and nurses to provide care and treatment for AIDS in the PHCs in rural areas. GHAIN will support the establishment of a pilot/model comprehensive HIV/AIDS service in a rural Local Government Area (LGA) of Cross River State and an urban LGA in Kano State. GHAIN will also strengthen the capacity of the care and treatment teams in its focus health facilities including the GoN supported Federal Medical Centers in these states, to implement harmonized quality services with strong focus on adherence and ensuring durability of first line drugs, such that no differences in the quality of services are received by patients, regardless of the source of donor funding or the health facility where services are being obtained. GHAIN will also strengthen the national paediatric program through a mentorship program in collaboration with the Clinton Foundation. The patient management and monitoring (PMM) system established by GHAIN will be strengthened and additional standard operating procedures (SOPs) for care and treatment services, including prevention for positives integrated into care and treatment will be developed and implemented to ensure continuous quality assurance/quality improvement (QA/QI). GHAIN will participate in the joint supervisory visits that will be carried out by the government of Nigeria/United States Government (GON/USG) to ensure high quality of services in all its project sites. Pediatric ART which makes up 10% of the adult antiretroviral (ARV) services provided will be implemented with the same quality as the adult ART.

GHAIN supports the GON in the design of the ART-PMM system and the National curricula and SOP for Pediatrics, so all National ART accomplishments ensured in addition to the GHAIN direct ones will be GHAIN's indirect targets.

GHAIN will build upon its achievements and experiences of COP 06 to support the GON's initiative of putting 250,000 PLWHAs on ART by training 288 persons to provide ART services to a cumulative number of 34,293 including 19,253 new PLWHAs by supporting 28 existing ART sites, establishing 17 new sites and increasing geographical coverage with a focus on rural areas from the current six states (FCT, Anambra, Lagos, Kano, Cross River and Edo states) to eight new states, namely Akwa Ibom, Kogi, Enugu, Taraba, Adamawa, Bauchi, Benue and Niger States. Depending on performance of GFATM, this expansion plan may need to be revised.

CONTRIBUTIONS TO OVERALL PROGRAM AREA The provision of ART services through this program will contribute to strengthening and expanding the capacity of the GON's response to the HIV/AIDS epidemic and increasing the prospects of meeting the Emergency Plan's goal of providing life-saving antiretroviral treatment to 350,000 individuals. Planned decentralization of services to PHCs in all 10 focus States will improve equity in access to HIV treatment and care services. GHAIN supports the GON in the design/implementation/update of the ART-PMM system, the design of the National curricula and SOP for Pediatrics, and participates fully in National and State level working groups and coordinating bodies. This not only ensures strong community collaboration and buy-in, but also contributes to capacity building and sustainability at all levels.

LINKS TO OTHER ACTIVITIES

This activity relates to activities in Counselling and testing (#6702), TB/HIV (#6700), PMTCT (#6706), OVC (#6701) and Care and support (#6708). Treatment services will continue to be linked to community services to support persons on ARV treatment by providing counseling to them and their families to encourage adherence; provide information to PLWHA who are not yet on ARV treatment but are likely to be in the future; promote HIV testing and integration of prevention into care and treatment programs; target HIV positive clients for prevention, care and support opportunities for them and all their family/household members. Programs will be developed by building upon the lessons learned from family based care approaches currently implemented by GHAIN in Kano and Lagos. The multi-directional referral linkages that will be established will also improve psychosocial support and adherence, and reduce treatment failure and resistance. ARV and Tuberculosis (TB) clinic linkages will be strengthened and fostered in all focus sites.

Negotiations are currently underway with the GON to leverage Global Fund resources to provide a dramatic increase in numbers that will be provided with ART services. According to this strategy, after services have been initiated, and providers are well trained and systems are in place, the sites will be handed over to the GON for continued support with Global Fund resources. This will in turn allow GHAIN to initiate another set of new sites without having to bear ongoing maintenance costs. Technical assistance, monitoring and evaluation, and supportive supervision will continue in all sites throughout the life of the project and will ensure strong capacity-building, powerful ownership, and guaranteed sustainability.

POPULATIONS BEING TARGETED This activity targets orphans and vulnerable children who are HIV positive; PLWHAs; HIV+ TB patients, and HIV+ pregnant women. Indirect targets will include patients who will be reached through ripple effects from the staff of GON and other organizations that will utilize the trainings, treatment documents, curricula and standard operating procedures that will be obtained with technical support from GHAIN.

KEY LEGISLATIVE ISSUES ADDRESSED GHAIN will put in place mechanisms to reduce stigma and discrimination both among health workers and the general population, and will provide opportunities for increasing gender equity in access and reducing the potential for violence against women by increasing couples counseling and testing and expanding family-centered treatment options.

EMPHASIS AREAS This activity includes major emphasis on expansion of ART service delivery and minor emphasis on training, quality assurance, quality improvement and supportive supervision. GHAIN will also continue to strengthen its exit/sustainability plan both at the country and program levels by building capacity of health facilities to implement comprehensive ART programs and customizing specific handover plans and schedules for each facility. The plans will include indicators for measuring capacity as well as a time line based on key benchmarks with a view to ensuring ownership and sustainability.

Funding for Laboratory Infrastructure (HLAB): $4,809,260

ACTIVITY DESCRIPTION ACTIVITY DESCRIPTION The Global HIV/AIDS Initiative Nigeria (GHAIN) laboratory component has the responsibility of providing standard, accurate and reliable results and practices that are replicable and valid in accordance with existing Government of Nigeria (GoN) guidelines. GHAIN has put in place strategies to significantly strengthen and expand laboratory services as well as upgrade infrastructure in all GHAIN supported HIV treatment sites.

GHAIN will embark on an integrated expansion of laboratory training, covering HIV diagnosis, treatment and care. All training for specific assays will be linked with training on Good Laboratory Practices, Laboratory Management and Quality Assurance/Quality Control (QA/QC), laboratory practicals and on-site follow-up. The GHAIN laboratory staff will coordinate and provide technical support at the sites, ensure QA and state level inventory management of laboratory supplies, including test kits and reagents.

To provide good mechanism for capacity building, supervision and quality assurance/quality improvement (QA/QI), GHAIN will leverage resources from GFATM to support hiring of two Lab technical officers per zonal office, with the technical leadership of the Country Office Senior Lab Advisor. The responsibilities of the lab team will include overall capacity building/technical assistance and supervision of all GHAIN supported sites, coordination of inventory management system for commodities, QA; promote collaborations and networking opportunities with other Implementing Partners (IPs) and GON.

GHAIN will continue to use a centralized procurement and distribution strategy to ensure that needed reagents and consumables are available at all focus sites. Laboratories at the new sites will be rolled out and linked to existing sites through an integrated tiered national laboratory network. GHAIN will also establish linkages with sites that have the necessary technology to obtain polymerase chain reaction (PCR) laboratory services for fees; utilizing dried blood spots (DBS) for expansion of infant diagnosis to all its prevention of mother to child transmission (PMTCT) supported sites.

Quality assurance/quality control of laboratory services will be ensured to support HIV diagnosis, treatment and care. The essential components of a Quality system will be put into place at each site and quality assurance (QA) will be ensured through quarterly on-site visits using standardized checklists and External Quality Assurance (EQA). Reports will be generated and fed back to the sites. All non-conformities will be addressed and remedial action taken to rectify problems in the testing process. In addition to the GHAIN laboratory personnel, technical assistance (TA) will be provided by the Association of Public Health Laboratories (APHL)/USA for the development of an overall laboratory QA program for GHAIN. GHAIN will ensure a tiered system of laboratories by working with other IPs to develop a future equipment plan; supply chain and maintenance in all GHAIN supported sites. GHAIN will also participate in the laboratory working group and in setting standards for all laboratory related activities.

GHAIN will provide laboratory services to 59,503 People Living with HIV/AIDS (PLWHAs) by supporting 28 existing antiretroviral therapy (ART) sites, establishing 17 new sites with comprehensive laboratory services (in secondary facilities) and increasing coverage by going to eight new states, namely Akwa Ibom, Kogi, Enugu, Taraba, Adamawa, Bauchi, Benue and Niger States. Depending on performance of GFATM, this expansion plan may need to be revised. 677,289 tests will be conducted in COP07. GHAIN will avail its laboratory personnel of the opportunity from Centers for Disease Control (CDC) - Nigeria Laboratory Management Training of Trainers (TOT) workshop for laboratory staff. These staff (laboratorians) will be expected to pass this training along to 258 laboratory managers/staff at all GHAIN supported sites through didactic and on-site capacity building processes.

CONTRIBUTIONS TO OVERALL PROGRAM AREA The provision of Laboratory services through this program will contribute to strengthening and expanding the capacity of the government of Nigeria (GoN)'s response to the HIV/AIDS epidemic. GHAIN will work with GoN using established national rules and guidelines on laboratory services to build the capacity of laboratory staff at the project sites. This program will also contribute to infrastructural upgrade of the health facilities

and provide necessary equipment. Considering the complexity of antiretroviral therapy (ART) and the strict requirements for standards and procedures, the laboratory component will aim to establish a well coordinated and efficient quality assurance, supervision and monitoring system at all the GHAIN sites.

LINKS TO OTHER ACTIVITIES: This program element relates to activities in HVCT (6702), MTCT (6706), HTSX (6703), HBHC (6708), HVTB (6700), HKID (6701), and HMBL (6710). A referral linkage system will be strengthened to ensure that clients are referred from sites with limited or no laboratory infrastructure to automated laboratory sites using the integrated tiered national laboratory network. GHAIN will implement GoN approved testing algorithm and work with the GoN and other stakeholders on the use of non-cold chain Rapid Test Kits (RTK) for HIV testing. With the new scale up strategy for counseling and testing (CT), GHAIN will build the capacity of counselors both at the CT and PMTCT sites on the use of non cold chain dependent algorithm for HIV testing. GHAIN will also introduce sputum smear microscopy and tuberculosis (TB) treatment in all CT sites.

POPULATIONS BEING TARGETED This activity will provide laboratory services to PLWHAs, (including pregnant women), HIV positive children, tuberculosis (TB) patients including those that are HIV positive and are eligible for ART, HIV positive infants and other most at risk populations (MARPS). These clients will be generated from PMTCT, Care and Treatment, mobile and facility based counseling and testing and TB-HIV programs. The Family Centered Care Model approach will be adopted to reach the HIV/AIDS affected families.

KEY LEGISLATIVE ISSUES ADDRESSED This program element will promote increasing gender equity in HIV/AIDS by ensuring that the laboratory services will address the needs of both males and female in all age groups. Stigma and discrimination will be reduced by ensuring confidentiality of test results.

EMPHASIS AREAS Major emphasis will be placed on quality assurance, quality improvement, and supportive supervision. Minor emphasis will be placed on Laboratory infrastructure upgrade, including commodity procurement (laboratory equipment and reagents) and local organizational capacity development through trainings and on-site technical assistance and mentoring. GHAIN will also continue to strengthen its exit/sustainability plan by building the capacity of laboratorians implementing HIV/AIDS programs, and customize a specific plan and schedule for each facility.

Funding for Strategic Information (HVSI): $2,150,000

ACTIVITY DESCRIPTION This activity relates to PMTCT (#6706), Basic Care and Support (#6708); TB-HIV (#6700); Counseling and Testing (#6702); ARV Services (#6703); Blood Safety (#6710); Condom and Other Preventions (#6707), ARV Drugs (#6705); and Laboratory Infrastructure (#6709).

GHAIN will provide SI support to 176 organizations at national level and in Anambra, Edo, FCT, Kano, Kogi, Cross River, Lagos, Niger, Enugu, and Akwa Ibom states. The GHAIN M&E plan is tailored to respond to the information needs of the Governments of Nigeria (GON) and the United States (USG). GHAIN's 3 main M&E components are: Program Monitoring and Evaluation (PME), Patient Management and Monitoring (PMM) and Quality Assurance/Quality Improvement (QM). GHAIN liaises closely with the USG IPs and the UN to facilitate implementation of the Three Ones. GHAIN will ensure that points of service (POS) and their M&E staff own the SI system by building SI capacity, systematizing feedback sessions, and strengthening SI networks at State and National levels. To ensure sustainability of SI efforts, GHAIN does not provide remuneration to any government SI staff.

The PME component will update the comprehensive database and data management processes for all GHAIN supported services, implement tools to collect data on all project activities, and the provide regular feedback to the GON, the USG, POS and other stakeholders. PME also includes the provision of technical assistance (TA) to the GON to strengthen the national PME system including the design and implementation of PME tools. GHAIN will also carry out regular and standardized monitoring activities in POS and provide TA to sub-grantees to strengthen their M&E capacity.

The PMM component will strengthen the PMM systems for ART, PMTCT and facility based PC programs. GHAIN will provide to the GON ongoing TA in developing and expanding the National ART-PMM system in close collaboration with USG IPs and the UN. Efforts will continue to ensure regular and effective feedback to POS, the USG and the GON. GHAIN will continue to participate in the USG HMIS technical working group (TWG) and collaborate closely with other IPs.

The QM component will: assist the GON to document/update National guidelines upon request; provide technical leadership in QM to the relevant TWGs; and strengthen the GHAIN comprehensive QM System through the creation/revision of references and other QM tools. This component will develop and implement new concepts for QM such as the regular use of standardized qualitative methodologies for service provider assessments.

CONTRIBUTION TO OVERALL PROGRAM AREA This activity will enhance client/patient management and implementation of all program elements by making quality data available at all levels for monitoring, guiding program management and tracking program achievements. Functional feedback measures will be developed to ensure that results of monitoring activities inform program design and management, build capacity in M&E at all levels and provide QM tools, protocols and reports. This activity will ensure that services provided by GHAIN are of the highest quality. Others shall include scientific publications (abstracts, posters, presentations at conferences) and research and surveillance protocols.

This funding will specifically go to facility monitoring and quality management assessments and Health Management Information. Funding emphasis will also go to information and communication technologies (ICT) infrastructure, monitoring, evaluation, or reporting or at program level data collection as well as capacity building for 367 people in SI. Funds will be used to support studies that address evaluation questions in relation to PEPFAR-provided services, the USG database for ART-PMM and reporting systems and other SI activities in 176 organizations.

LINKS TO OTHER ACTIVITIES High quality data are required for effective and efficient client/patient and program management. These data shall come from PMM, PME, QM as well as from research and surveillance. HVSI will continue producing and facilitating the use of these information at POS, state and National level: to ensure client/patient management (especially for PMTCT-#6706, HBHC-#6708; HVTB-#6700; HCT-#6702; HTXS-#6703; and to pilot

programs (same 5 programs plus HVOP-#6707; HTXD-#6705; and HLAB-#6709)

POPULATIONS BEING TARGETED HVSI will target principally SI professionals working in community-based organizations, faith-based organizations, non-governmental organizations, implementing organizations, country coordinating mechanisms and international counterpart organizations. And more generally, collaborative initiatives in this regard promote generation of information that will inform program decisions by health workers, donors and the GON as well as guarantee quality of service delivery to primary beneficiaries of these services.

KEY LEGISLATIVE ISSUES ADDRESSED This activity provides information to increase gender equity in HIV/AIDS programs through activities such as collecting data to show breakdown of women and men receiving prevention activities, treatment, care services and developing strategies to ensure that gender-specific issues are addressed. The program area will also make the most of existing partnerships to strengthen the capacity of organizations implementing various projects/programs.

EMPHASIS AREA HVSI will emphasize on monitoring and evaluation, reporting, or at program level data collection while minor emphasis will be on local organization capacity development, quality management, HMIS, information and communication technologies (ICT) infrastructure.

Subpartners Total: $12,105,661
Axios Foundation: NA
Howard University: $200,000
Central Hospital Auchi: $61,473
Central Hospital Uromi: $16,802
Lagos Island General Hospital: $70,071
Society for Women and AIDS: $505,632
Life Link Organization: $77,158
Murtala Mohammed Specialist Hospital: $150,947
Massey St. Children's Hospital: $79,814
General Hospital, Onitsha: $116,156
Holy Rosary Hospital, Onitsha: $14,440
St. Mary's Hospital, Nigeria: $62,656
General Hospital, Abaji: $16,985
District Hospital Maitama: $84,498
Nigerian Custom Hospital, Karu: $16,985
General Hospital, Nyanya: $16,985
Wudil General Hospital: $25,185
Sabo Bakin Zuwo Hospital: $21,477
General Hospital, Calabar: $185,604
Central Hospital Benin: $109,017
General Hospital, Wuse: $56,668
Lagos Island General Hospital: $144,698
General Hospital, Ekwulobia: $48,000
General Hospital, Awka: $77,476
General Hospital, Ugep: $238,086
Holy Family Catholic Hospital : $123,973
Notre Dame Hospital: $14,440
General Hospital, Kubwa: $64,835
Surulere General Hospital: $33,172
General Hospital, Gwarzo: $27,316
Nuhu Bamalli Hospital: $23,948
General Hospital, Ajeromi: $61,496
General Hospital, Badagry: $71,085
General Hospital, Epe: $25,897
General Hospital, Ikorodu: $73,909
General Hospital, Isolo: $61,517
Infectious Disease Hospital, Kano: $259,754
FHI 360: $2,250,000
General Hospital, Obanliku: $64,397
General Hospital, Akpet: $51,929
Primary Health Centre, Ikot Omin: $14,957
Primary Health Centre, Ofatura: $14,957
National Union of Road Transport Workers: $230,078
Salvation Army: $187,535
Apapa Comprehensive Health Center: $26,095
Ebute Meta Health Center, Lagos: $27,901
Igando Ikotun Primary Health Care Center, Lagos: $25,724
General Hospital, Gbagada: $27,439
Mushin Primary Health Care Clinic: $29,742
Fortress for Women: $97,581
General Hospital, Kura: $48,780
General Hospital, Danbatta: $26,679
St. Charles Borromeo: $111,471
Redeemed Christian Church of God: $198,299
Lagos State AIDS Control Agency: $80,361
All Saints Clinic: $81,344
General Hospital, Bwari: $62,421
Catholic Action Committee on AIDS Hospitals: $132,163
General Hospital, Kuje: $62,441
General Hospital, Kwali: $56,668
State Action Committee on AIDS Kano: $52,267
Anambra State Action Committee: $59,440
Evangelical Church of West Africa: $45,621
Tiga General Hospital: $52,279
Hasiya Bayero Pediatric Hospital: $52,279
Matage Health Center: $52,940
Sheikh Mohammed Jidda Hospital: $27,316
St. Louis Catholic Clinic and Maternity: $53,441
Specialist Hospital, Ossiomo: $24,678
General Hospital, Iruekpen: $48,623
Federal Polytechnic Medical Center: $29,806
Edel Trant Community Hospital Nkpologu: $54,132
Nwafor Orizu College of Education Medical Center Nsugbe: $24,894
Oriade Primary Health Centre: $31,951
Orile Agege General Hospital: $31,224
Comprehensive Health Center: $24,751
Presbyterian Tuberculosis and Leprosy Hospital Mbembe: $23,524
St. Benedict Tuberculosis and Leprosy Hospital : $28,157
University of Calabar Teaching Hospital: $22,547
St. Mary's Catholic Hospital, Gwagwalada: $142,326
Nnewi Diocesan Hospital: $31,980
Regina Mundi Catholic Hospital: $39,342
Lutheran Hospital Yahe: $21,475
Nigerian Armed Forces Program on HIV And AIDS Control: $19,582
Primary Health Center Utanga, Obanliku: $14,957
St. Philomena Catholic Hospital, Benin: $40,123
Crusade for Greater Nigeria: $31,537
General Hospital, Lagos: $43,755
Primary Health Center Ikot Okpora, Biase: $16,102
Primary Health Care Centre, Boki: $16,012
Primary Health Center Efraya, Etung: $53,268
Primary Health Center Obudu Ranch, Obaniku: $8,485
National Union of Road Transport Workers: $37,887
National Union of Road Transport Workers: $33,080
International Planned Parenthood Federation: $39,390
Nka Iban Uko: $32,040
Society Against the Spread of AIDS: $31,928
General Hospital, Oju: $102,909
General Hospital, Gboko: $102,909
General Hospital, Katsina: $102,909
General Hospital, Oban: $36,636
General Hospital, Obubra: $38,545
General Hospital, Akamkpa: $37,705
Mambilla Baptist Hospital: $119,245
First Referral Hospital: $102,456
General Hospital, Zing: $102,456
General Hospital, Kontagora: $103,909
General Hospital, Suleja: $106,829
General Hospital, Minna: $104,607
General Hospital, Wukari: $102,756
Mohammed Abdullahi Wase Hospital: $21,477
General Hospital, Enugwe: $21,101
Regina Caeli Maternity Hospital Awka: $42,805
Immaculate Heart Hospital and Maternity : $43,354
Iyi Enu Hospital: $42,805
General Hospital, Ankpa: $166,305
District Hospital, Agbani: $166,305
District Hospital, Udi: $166,305
District Hospital, Enugu Ezike: $164,717
General Hospital, Obi: $170,122
General Hospital, Nassarawa: $170,122
Federal Medical Centre, Jalingo: $160,026
General Hospital, Bali: $175,549
General Hospital, Oji River: $32,229
General Hospital, Biu: $173,594
General Hospital, Bama: $181,228
State Specialist Hospital, Maiduguri: $180,083
Nigerian Armed Forces: $76,924
General Hospital, Warri: $165,771
General Hospital, Ekpan: $40,356
General Hospital, Sapele: $40,356