ACTIVITY DESCRIPTION This activity also relates to activities in care & support (#6672), ARV services (#6766) & Laboratory infrastructure (#6767). The International Foundation for Education and Self- Help (IFESH) will increase the PMTCT sites it supports from 8 in COP06 to 12 in COP07 and provide counseling and testing to 4,750 pregnant women and provide Antiretroviral (ARV) prophylaxis to 190 clients. Counseling and Testing (CT) using the Opt- Out approach will be offered to all pregnant women at antenatal clinic and in labor. Same day results will be provided at all points of services. Post test counseling will be offered to all women and partner testing will be offered on site. The new ‘Testing & Counseling for PMTCT' support tools produced by CDC, USAID and WHO will be adopted for use in our sites. HIV + pregnant women will have access to laboratory services including CD4 measurements. Women requiring HAART for their own health care will be provided with the same, utilizing the WHO and National Guideline as basis for treatment decisions. HIV-infected women, ineligible for ART will be offered a combination of Zidovudine(AZT) from 28 weeks and Single Dose Nevirapine (SD-NVP) at onset of labor. Women presenting in labor will be offered rapid testing and if HIV-infected provided with SD-NVP. All infants born to HIV infected women will be provided with SD-NVP at birth and AZT for 6 weeks. Significant Changes between 2006 and 2007 will include the Training of more lay counselors and Community Health Extension workers (CHEWs) to encourage home based CT and follow- up of all clients that pass through the PMTCT Program ensuring that referrals are followed through. Infant feeding counseling will start from ANC and continue through post partum. Community based workers will also ensure that infant feeding options are in accordance with the WHO and the newly adopted Nigerian infant feeding guidelines. Cotrimoxazole prophylaxis will be provided to all exposed infants from 6 weeks and continued pending a diagnosis. Infant diagnosis will be by referral to a PEPFAR DNA PCR site using the newly introduced dried blood spot (DBS) collection technique. IFESH plans to use Supervisory teams who will pay quarterly visits to all sites to ensure quality of care. In line with the Memorandum of Understanding (MOU) signed with the Rivers State Government, all HIV+ clients will be referred post partum to the State ARV Clinic and Pediatric HIV Clinic for continued care. IN COP 07, 80 PMTCT service providers will be trained using the National PMTCT Training Manual. Quality Assurance (QA) for both Counseling and testing will be carried out at timely intervals in COP 07 through submitting blood samples from every tenth tested client to a designated reference laboratory for testing and sending certified counselors for site assessments. All 12 sites will use the National PMTCT Registers and data collection for Monitoring and Evaluation of all activities in line with the Principle of "The 3 ones". IFESH is presently supporting PMTCT services at 8 sites and will support an additional 4 in COP 07 for a total of 12 sites. All sites will be in Rivers State. CONTRIBUTIONS TO OVERALL PROGRAM AREA: Supporting 12 sites in rural areas of Rivers is in line with the desire of the Government of Nigeria to have 1,200 PMTCT sites operational by the year 2008 and the USG`s target of having 80% coverage for PMTCT across the country. LINKS TO OTHER ACTIVITIES: This activity is linked to activities in care & support (#6672), ARV services (#6766) & Laboratory infrastructure (#6767).Prevention for positives counseling will be integrated within PMTCT care for HIV+ women. The basic package of care provided to all HIV+ patients will be available to HIV+ pregnant women. Women requiring HAART for their own health care will be linked to within network ARV services. Laboratory staff will ensure that HIV testing provided within the PMTCT context is of high quality by incorporating PMTCT sites into the laboratory QA program. POPULATIONS BEING TARGETED: This activity targets Men and women of reproductive age, Family Planning clinics, pregnant women, their spouses or partners and the children of the index pregnancy and Health care workers. Pregnant women will be provided with PMTCT services, while HIV+ Mothers, their infants and infected partners will access ART services. Uninfected women will be supported to remain HIV negative. CBOs, FBOs, support groups and men will also be targeted so that they participate fully in community based PMTCT services. Health care providers will be trained on providing services while management skills of GoN policy makers and implementers at all levels will be improved to enable them manage programs effectively. New sites will include those with lay counselors from the community who are to ensure adequate follow- up and community acceptance. KEY LEGISLATIVE ISSUES: This activity will address Gender equity in prevention programming through breakdown of figures of men and women who attend community mobilization, who assess counseling. It will also address this legislative issue through mobilization of communities to address issues which bring about cross generational and transactional sex. In PMTCT it will provide training to health workers and lay counselors on couple counseling, risk assessment and stigma reduction. It will also address the issue of addressing violence linked to disclosure by actively educating

the community male and females on the issues of HIV/AIDS and the danger of stigmatization. Women will be linked to other sources of care and income generating activities. EMPHASIS AREAS: The PMTCT service has major emphasis in commodity procurement and minor emphasis in training, community mobilization, local organization capacity development and development of linkages/ referral networks. This is through purchase of antiretrovirals, Shipment, Storage and timely delivery to the different sites. We organize community outreaches, Advocacy visits and use appropriate Information, Education and Communication (IEC) materials. The health centers, CBOs and non-governmental organizations have their capacity developed through trainings and this will make for sustainability of programs. Strong referrals linkages are also developed.

ACTIVITY DESCRIPTION: With COP07 funding, IFESH will provide basic care and support services to individuals identified as HIV+ from C&T. Basic care and support services will be provided in 5 sites, (where VCT & PMTCT services are provided) located in Rivers, Imo and Benue States. This activity provides a critical component of the complete HIV related care package by offering initial care and support to HIV-infected individuals. Under COP07 activities IFESH will provide basic care and support services to 1900 PLWHA. HIV positive persons identified through mobile/community HCT and PMTCT activities will be provided with basic care services including: patient training and education in self care, medical services (assessment of signs and symptoms and referrals), psychological care (adherence, crisis, bereavement), nutritional counseling, prevention for positives, fellowship to share coping mechanisms through enlisting in a support group, provision of cotrimoxazole prophylaxis, pain and symptom management, and access to community home based care services. PLWHAs will be provided with prevention care packages containing water treatment, water vessel and Insecticide Treated Nets (ITNs). All identified HIV positive persons will be referred to treatment facilities with comprehensive HIV/AIDS related services for baseline laboratory investigations and for ART where indicated. Laboratory monitoring (CD4 counts, hemotology, blood chemistry, and malaria smears) will be supported from this funding. IFESH will facilitate support group activities to combat denial, stigma and discrimination. Funds will support the recruitment of a Care & Support program staff to supervise and monitor program activities in the field. Community home based care will be provided in the catchments areas that IFESH supports. This will be implemented by trained community health extension workers and community volunteers, among whom would be retired nurses and midwives within the community and volunteer PLWHA from support groups. This activity will be linked to the primary prevention and VCT programs emphasizing the "home-based" prevention linkage to ensure that family members at risk are tested and counseled, a strategy that supports family engagement in home-based care and support. Home based care providers will be organized into a team that is linked to a facility within their catchment area. IFESH will collaborate with other IPs so that a standard training curricula is utilized and standard provider manuals are distributed. There will be training of new health care workers (HCW) including community volunteers and re-training sessions for the previously trained HCWs. The training will equip the trainees with the capacity to provide basic care and support services (OI prophylaxis, psychosocial support, home based care). A total of 40 care providers will be trained. The capacity of already existing healthcare facilities in the targeted areas will be strengthened to provide quality care and support to the PLWHAs. Healthcare workers in the general hospitals and the surrounding health centers will be mobilized, sensitized, trained and equipped to provide these services. IFESH will provide outreach services at each site to HIV-infected and uninfected individuals through HCT advocacy, anti-retroviral therapy education, stigma reduction, and risk reduction through other prevention activities. Funding will directly support the provision of care and support services to clients attending the sites. Sites are located in states chosen based upon high prevalence in the most recent 2005 antenatal HIV sero-survey and geo-political distribution. They include: Rivers, Benue, and Imo states.

CONTRIBUTIONS TO OVERALL PROGRAM AREA: This activity provides services which are a high priority for the 2-7-10 Emergency Plan strategy by providing a basic package of care for all HIV+ adults and People affected by AIDS. The services are consistent with the draft Guidelines for Palliative Care in Nigeria and the USG Palliative Care Policy as well as the Nigerian Guidelines for Antiretroviral Therapy which stress home based care, symptom management, and OI prophylaxis. Capacity development and consistency with national guidelines will ensure sustainability.

LINKS TO OTHER ACTIVITIES: This activity also relates to activities in Counseling & Testing (6748) and PMTCT (6725). All patients are monitored and linked to ARV therapy when indicated. Care and Support services such as psychosocial support and symptom management promote ARV adherence. Services will be integrated with prevention for positives activities including counseling and condom availability. Home based care programs will be implemented by a number of indigenous NGOs, CBOs, FBOs. Sub-agreements will be coordinated with other Emergency Plan IPs to ensure non-overlap of funding and services. Women will be linked to other sources of care and Income Generating Activities (IGAs) where available.

POPULATIONS BEING TARGETED: Services are offered to adults living with HIV/AIDS and their affected family members, men and women of reproductive age, pregnant women, their spouses or partners, the children of index pregnancy and health care workers. Sites have been chosen to maximize linkage with USG supported facilities providing comprehensive HIV treatment services and provide services for HIV+ pregnant women identified through PMTCT. Nurses, other health workers as well as volunteer PLWHA and caregivers of PLWHAs are targeted for training.

KEY LEGISLATIVE ISSUES ADDRESSED: This activity addresses the key legislative issue of "Gender" since services will be provided equitably to women and data will be collected to demonstrate this. The activity also addresses the key legislative area of "Stigma and Discrimination" as training of health care workers and community volunteers will reduce stigma, mobilization of communities to address issues which bring about cross generational and transactional sex.

EMPHASIS AREAS: The major emphasis area for this activity is "Training" as capacity development for sustainability is a key focus. Minor emphasis areas for this activity include "Commodity Procurement" and "Logistics" as pharmaceuticals and supplies are provided to sites and secondary partners to facilitate service provision.

ACTIVITY DESCRIPTION: This activity is linked to C&S 6747. Funding for COP06 was not received until COP07, therefore IFESH will also be conducting COP06 activities in COP07. See the COP06 narrative for targets to be reached under that funding in COP07. Under COP07 funding, IFESH will provide access to quality HIV counseling and testing (CT) services to 12,000 individuals. Services will be provided in 4 sites in Rivers & Imo States. In order to accomplish this, CT services will be targeted to populations that have been shown to be at increased risk for being infected with HIV through high-risk behavior. Targeting this population will identify HIV infected individuals and to provide them with appropriate counseling, care and treatment. Additionally, negative individuals identified through this activity will be provided and referred to appropriate prevention services. A total of 12,000 people will be counseled, tested and receive results. All individuals requiring treatment will be referred to ART treatment sites in the states. IFESH will be providing CT services in TB DOTS centers, especially in IFESH PMTCT sites already providing DOTS services. CT services will be integrated into existing PMTCT sites in order to increase access to CT by other family members. All positive clients not identified through CT in a TB DOTS site will also be referred to the state TB clinics for TB screening. Funding will be used to support the training of staff utilizing HIV counseling and testing SOPs and the standardized of a GON endorsed training curriculum. 40 people will be trained on counseling and rapid testing at the 4 service outlets. Some of those trained will be community health workers who will do mobile VCT in order to carry out family VCT and house-to-house testing campaigns during PMTCT home care visits. Training will be appropriately tailored to the targeted population to which it will be delivered, and counseling will be provided in local languages whenever possible. In view of the remoteness of most communities in these states and the trend towards home-based testing, IFESH will establish mobile VCT service outlets specifically to target hard-to-reach high risk groups such as commercial sex workers and truck/long distance drivers at community and ward levels. Due to the risk of HIV infection among these populations, a key component of the CT delivery will include enhancing the linkage of the HIV infected individuals to HIV care and treatment services as necessary. IFESH will educate communities in local languages in order to increase awareness of such services. Counselors fluent in these local languages will be available to ensure appropriate counseling messages are conveyed to the clients. All testing will be conducted using the nationally approved algorithm for HIV testing that is appropriate for the specific environment in which they work. Simple, rapid tests which allow for immediate delivery of HIV diagnosis will be prioritized for use to increase the capacity for expanding access to services and receipt of results by the clients. Laboratory program officers to assist with training and a quality assurance program will be in place to ensure the accuracy of testing particularly for testing conducted outside of health facilities. Quality Assurance (QA) for both counseling and testing will be carried out at timely intervals in COP07 through submitting blood samples from every tenth tested client to a designated reference laboratory for testing and sending certified counselors for site assessments.

CONTRIBUTION TO THE OVERALL PROGRAM: The activities supported with these funds are in-line with both the Government of Nigeria (GON) and the Emergency Plan 5-year strategy for addressing HIV/AIDS. Increasing access to CT, particularly to high risk populations, is an efficient strategy to identifying individuals that will benefit from prevention, care, and treatment activities. Clients found to be infected with HIV will be linked with prevention (for positives), care and treatment support. Those individuals found to be HIV negative will be provided with prevention services by trained staff.

LINKS TO OTHER ACTIVITIES: These activities are related to HVOP (6746) and HBHC (6747).

POPULATIONS BEING TARGETED: This activity targets those individuals known to be at increased risk of HIV infection in Nigeria. These include commercial sex workers, military populations, mobile populations, truck drivers, and street youth. To accomplish this, CT services will be located where such populations are known to congregate.

KEY LEGISLATIVE ISSUES: This activity will make special effort to provide CT services to woman (through CT targeted at CSW).

EMPHASIS AREAS: This activity includes major emphasis on training with minor emphasis on network linkages/referral systems, quality assurances and supportive supervision, and

information, education, and communication.