Reprogramming 9/07: $200,000 reprogrammed in support of the Government of Nigeria PMTCT programs through increased direct technical support at post.

ACTIVITY DESCRIPTION: This MTCT activity relates directly to all Nigeria PMTCT COP07 activities (see ID references in narrative below).

The USG team, through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria has two full time staff positions (one Senior Program Specialist and one Program Specialist) planned for PMTCT, both of which are presently approved and hired under COP06 authority and funding. The budget includes funding for two and FSN salaries, ICASS and CSCS charges related to these staff positions, funding for (limited) international and required domestic travel, training funds and allocated minor support costs. The funds planned in this activity also include HHS/CDC HQ Technical Assistance travel for six weeks of in-country support by PMTCT area specialists.

These HHS/CDC PMTCT staff members will work in close coordination with the USAID PMTCT staff (#6812) and directly provide quality assurance and program monitoring to all HHS supported implementing partners including: University of Maryland-ACTION (#6768), Harvard SPH-APIN (#6718), Columbia University, SPH-ICAP (#6699), International Foundation for Education and Self-Help (IFESH) (#6725), Catholic Relief Services-Aids relief( #6675) ; and three PMTCT partners to be determined by RFAs awarded in the last quarter of 2006 (#6744 & #6749). CDC PMTCT staff will also assist USAID staff in joint monitoring visits of Family Health International-GHAIN (#6706), Catholic Relief Services-7 Dioceses (#6685), and a USAID APS partner (#6756) for COP06 to be selected. USAID and CDC PMTCT staff will provide assistance as needed to the U.S. Department of Defense (#6801) program with the Nigerian Ministry of Defense.

HHS/CDC and USAID PMTCT staff will provide technical support and capacity development to new partners undertaking PMTCT activities through the New Partner Initiative as well as provide support to the Government of Nigeria at the National and State levels to promote Nigeria National PMTCT guidelines. It is estimated that the PMTCT staff under this activity will provide monitoring and support to approximately 200 PMTCT sites in COP07.

ACTIVITY DESCRIPTION: This AB activity relates directly to all Nigeria AB COP07 activities (see ID references in narrative below).

The USG team, through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria proposes one half time staff position (one Program Specialist) for AB activities, the other half of the position will work in Condoms and Other Prevention activities. The budget in this activity includes funding for half of an FSN salary, ICASS and CSCS charges related to this position, funding for required domestic travel, training funds and allocated minor support costs.

This HHS/CDC AB staff member will work in close coordination with the USAID Prevention staff (#6776) and directly provide quality assurance and program monitoring to the HHS/CDC AB activity (#9832) to be announced by RFA in FY07. The HHS/CDC AB staff member will also assist USAID Prevention staff in joint monitoring visits of other USG supported AB program activities. USAID and CDC AB staff will provide assistance as needed to the U.S. Department of Defense (#6801) program with the Nigerian Ministry of Defense and technical support/capacity development to new partners undertaking AB activities through the New Partner Initiative. It is estimated that the AB staff under this activity will provide monitoring and support to approximately 25 AB sites in COP07, and up to 100 sites in COP08.

ACTIVITY DESCRIPTION: This HMBL activity relates directly to all Nigeria HHS Medical Transmission Blood Safety COP07 activities (see activity ID references in the narrative below).

The USG team, through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria will hire one full time staff position to support Medical Transmission prevention activities with 75% of time allocated to Blood Safety and 25% of time allocated to Safe Injection (see Activity ID 6817 for a more detailed description of safe injection responsibilities). The budget includes one FSN salary, ICASS and CSCS charges related to this position, funding for required domestic travel, training funds and allocated minor support costs. The funds planned in this activity also include HHS/CDC HQ Technical Assistance travel for one week of in-country support by two HHS/CDC GAP HQ Safe Blood program officers.

This Medical Transmission Prevention staff member will work in close coordination with the USAID Prevention staff (#6812) and directly provide quality assurance and program monitoring or coordination to HHS supported implementing partners with Blood Safety activities including: University of Maryland-ACTION (#6769), Harvard SPH-APIN (#6722), Columbia University, SPH-ICAP (#6698), Catholic Relief Services-AIDSRelief (#6676), the Nigeria Ministry of Health National Blood Transfusion Service (#6711), and the Safe Blood for Africa Foundation (#6730 & #6731). This position will also work with USAID on joint monitoring visits of non-HHS PEPFAR partners such as FHI-GHAIN (#6710) and give technical assistance to the DoD Safe Blood program (#6805) as requested.

This HHS/CDC staff member will also provide technical support and capacity development to new partners selected through RFAs, the New Partner Initiative and to the Government of Nigeria at the National and State levels to promote Nigeria National guidelines related to blood safety. It is expected that the staff member under this activity will provide direct or indirect monitoring and support to over 80 Emergency Plan supported clinical sites in COP07.

ACTIVITY DESCRIPTION: This HMIN activity relates directly to all Nigeria HHS Medical Transmission Injection Safety COP07 activities (see related activity ID references in the narrative below).

The USG team through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria will hire one full time staff positions to support Medical Transmission prevention activities with 75% of time allocated to Blood Safety and 25% of time allocated to Safe Injection. The budget includes one FSN salary, ICASS and CSCS charges related to this position, funding for required domestic travel, training funds and allocated minor support costs. The funds planned in this activity also include HHS/CDC HQ Technical Assistance travel for one week of in-country support by two HHS/CDC GAP HQ Safe Blood program officers.

This Medical Transmission Prevention staff member will work in close coordination with the USAID Prevention staff (#6812) and directly provide quality assurance and program monitoring to HHS supported implementing partners with Injection Safety activities: University of Maryland-ACTION (#6821), Harvard SPH-APIN (#6818), Columbia University, SPH-ICAP (#6819), Catholic Relief Services-AIDSRelief (#6820), and the Safe Blood for Africa Foundation (#6822).

This HHS/CDC staff member will also provide technical support and capacity development to new partners selected through RFAs, the New Partner Initiative and to the Government of Nigeria at the National and State levels to promote Nigeria National guidelines related to injection safety. It is expected that the staff member under this activity will provide direct or indirect monitoring and support to over 80 Emergency Plan supported clinical sites in COP07.

ACTIVITY DESCRIPTION As part of the USG team, the HHS/CDC Global AIDS Program (GAP) Office in Nigeria plans to hire a half time staff position in COP07 for Condom & Other Prevention area activities to provide in-country project oversight and technical assistance to all USG Implementing Partners that will be implementing Condom & Other Prevention activities in COP07. This half time individual will provide TA and program oversight to USG partners in implementing and strengthening programs to reach Most At-Risk Populations (MARPs) who are HIV-negative with prevention counseling and other services. Another emphasis area will be to integrate programming for prevention for HIV positives as an added component of Basic Care and Support.

This half time HHS/CDC BC&S staff position will work in coordination with the USAID Condoms and Other Prevention staff (#6779) and directly provide quality assurance and program monitoring to HHS supported implementing partners including: University of Maryland-ACTION (#9210), Harvard SPH-APIN (#9216), Columbia University-ICAP (#9208), Africare (#6672) and multiple partners to be determined by an RFA in COP07 (#9642, #9643, #9644). The HHS/CDC staff will also assist USAID staff in joint monitoring visits of Family Health International-GHAIN (#6707), Society for Family Health (#6735), and a Futures/ENHANCE (#6740. USAID and CDC Condoms and Other Prevention staff will provide assistance as needed to the U.S. Department of Defense program (#6804) with the Nigerian Ministry of Defense.

HHS/CDC and USAID Condoms and Other Prevention staff will provide technical support and capacity development to new partners undertaking Condoms and Other Prevention activities through the New Partner Initiative as well as provide support to the Government of Nigeria at the National and State levels to promote Nigeria HIV prevention programs. It is estimated that the staff under this activity will provide monitoring and support to over 80 clinical sites in COP07.

ACTIVITY DESCRIPTION: This HBHC activity relates directly to all HHS Nigeria Basic Care and Support COP07 activities (see ID references in the narrative).

To support and enhance the USG Nigeria Basic Care and Support activities, the USG team through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria has two full time staff positions planned that will focus on adult/adolescent palliative care/basic care and support issues. The budget includes two FSN salaries, ICASS and CSCS charges related to this staff position, funding for (limited) international and required domestic travel, training funds and allocated minor support costs. The funds planned in this activity also include HHS/CDC HQ Technical Assistance travel for two weeks of in-country support by ART/Care & Support specialists.

These HHS/CDC BC&S staff positions will work in coordination with the USAID BC&S staff (#6778) and directly provide quality assurance and program monitoring to HHS supported implementing partners including: University of Maryland-ACTION (#6770), Harvard SPH-APIN (#6719), Columbia University-ICAP (#6697), Catholic Relief Services-AIDSRelief (#6675), Africare (#6672) and a partner to be determined by an RFA in COP07 (#6754). The HHS/CDC staff will also assist USAID staff in joint monitoring visits of Family Health International-GHAIN (#6708), Catholic Relief Services-7 Dioceses (#6686), and a USAID APS partner (#6758) for COP07 to be selected. USAID and CDC Basic Care and Support staff will provide assistance as needed to the U.S. Department of Defense (#6802) program with the Nigerian Ministry of Defense.

HHS/CDC and USAID Palliative Care staff will provide technical support and capacity development to new partners undertaking BC&S activities through the New Partner Initiative as well as provide support to the Government of Nigeria at the National and State levels to promote Nigeria National palliative care guidelines. It is estimated that the BC&S staff under this activity will provide monitoring and support to over 80 clinical sites in COP07.

ACTIVITY DESCRIPTION: This HVTB activity relates directly to all HHS Nigeria TB/HIV COP07 activities (see ID references in the narrative below).

The USG team in Nigeria through HHS/CDC will utilize TB/HIV funds to support three full time TB/HIV program officers for the HHS/CDC Global AIDS Program (GAP) Office Clinical Care Unit in Nigeria. Each of these qualified FSN officers (one Senior Program Specialist, one Program Specialist and one TB/HIV Laboratory Technician) will have significant experience in program planning and implementation related to TB and HIV. They will be responsible for providing strategic leadership and technical support to the Government of Nigeria as well as to USG partners including: University of Maryland-ACTION (#6765), Harvard School of Public Health-APIN (#6713), AIDSRelief (#6677), Columbia University School of Public Health-ICAP (#6697), and the U.S. Department of Defense (#6795), Africare (#6672). The objective of this support is to develop and efficiently implement the USG's PEPFAR TB/HIV strategy as outlined in PEPFAR/Nigeria's 5-year strategy and the TB/HIV 5-year strategy recently developed by the Government of Nigeria. These strategies call for integrating TB and HIV services to allow TB patients to be counseled and tested for HIV and referred to HIV care as appropriate, and for patients infected with HIV to be adequately screened for TB and linked with care and treatment. Specific activities are the establishment of quality TB DOTS services at all HIV care points of service and the availability of confidential HIV counseling and testing at all TB points of service supported by PEPFAR. The budget includes funding for three FSN salaries, ICASS and CSCS charges related to these staff positions, limited international and required domestic travel, training and minor support costs. The funds planned in this activity are also expected to support 5 weeks of in-country Technical Assistance by TB/HIV program area specialists from HHS/CDC GAP HQ or relevant agencies as requested by the HHS/CDC GAP Office in Nigeria. These officers will take a leadership role in identifying additional local partners suitable for PEPFAR support in order to expand integrated and sustainable TB/HIV activities. They will also coordinate USG TB/HIV activities with other key TB and HIV initiatives such as the Global Fund Against HIV/AIDS, TB, and Malaria, The World Health Organization (WHO) (#6811), and The International Association of Anti-Leprosy Association (ILEP) in Nigeria. These officers will represent HHS/CDC as part of the USG team on the recently established National TB/HIV Working Group. This group has the mandate to provide national leadership for TB/HIV strategy, program development, and implementation. They will also work in coordination with the USAID Basic Care and Support TB/HIV staff and their partners (WHO, FHI/GHAIN #6700). This coordination will be in the form of joint work plans, regular meetings and communication between agencies, and joint internal and external TA to partners.

ACTIVITY DESCRIPTION: This HKID activity relates directly to all HHS Nigeria OVC COP07 activities (see ID references in the narrative below).

The USG Nigeria team, through the HHS/CDC Global AIDS Program (GAP) Office has one full time staff position planned for OVC that will focus on pediatric basic care and support issues. The budget includes one FSN salary, ICASS and CSCS charges related to this staff position, funding for (limited) international and required domestic travel, training funds and allocated minor support costs. The funds planned in this activity also include HHS/CDC HQ Technical Assistance travel for two weeks of in-country support by pediatric ART/Care & Support specialists.

This HHS/CDC OVC staff member will work in close coordination with the USAID OVC staff (#6782) and directly provide quality assurance and program monitoring to HHS supported implementing partners including: University of Maryland-ACTION (#6771), Harvard SPH-APIN (#6720), Columbia University-ICAP (#6694), Catholic Relief Services-AIDSRelief (#6679) and a partner to be determined by RFA in COP06 (#6751). The HHS/CDC staff will also assist USAID staff in joint monitoring visits of Family Health International-GHAIN (#6701), Catholic Relief Services-7 Dioceses (#6688), and a USAID APS partner (#6755) in COP06 to be selected. USAID and CDC OVC staff will provide assistance as needed to the U.S. Department of Defense (#6808) program with the Nigerian Ministry of Defense.

HHS/CDC and USAID OVC staff will provide technical support and capacity development to new partners undertaking OVC activities through the New Partner Initiative as well as provide support to the Government of Nigeria at the National and State levels to promote Nigeria National OVC guidelines. It is estimated that the OVC staff under this activity will provide monitoring and support to over 80 clinical sites in COP07.

ACTIVITY DESCRIPTION: This HVCT activity relates directly to all Nigeria VCT COP07 activities (see ID references in narrative below).

The USG team, through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria proposed one full time staff position (one Program Specialist) for VCT, to be approved and hired under COP07 authority and funding. The budget includes funding for one FSN salaries, ICASS and CSCS charges related to this position, funding for (limited) international and required domestic travel, training funds and allocated minor support costs. The funds planned in this activity also include HHS/CDC HQ Technical Assistance travel for two weeks of in-country support by VCT program area specialists.

These HHS/CDC VCT staff members will work in close coordination with the USAID TB/HIV staff (#6781) and directly provide quality assurance and program monitoring to all HHS supported implementing partners including: University of Maryland-ACTION (#6772), Harvard SPH-APIN (#6721), Columbia University, SPH-ICAP (#6695), Africare (#6673), International Foundation for Education and Self-Help (IFESH) (#6748), Catholic Relief Services-AIDSRelief (#6681) and new partners selected by CDC RFA (#6752, #9653, #9654). HHS/CDC VCT staff will also assist USAID staff in joint monitoring visits of Family Health International-GHAIN (#6702), Catholic Relief Services-7 Dioceses (#6687), and a USAID APS partner (#9884 & #6760) for COP06 and COP07 to be selected. USAID and CDC VCT staff will provide assistance as needed to the U.S. Department of Defense (#6796) program with the Nigerian Ministry of Defense.

HHS/CDC and USAID TB/HIV staff will provide technical support and capacity development to new partners undertaking TB/HIV and VCT activities through the New Partner Initiative as well as provide support to the Government of Nigeria at the National and State levels to promote Nigeria National VCT guidelines. It is estimated that the VCT staff under this activity will provide monitoring and support to approximately 150 VCT sites in COP07.

ACTIVITY DESCRIPTION: These funds are to be used by CDC for the preclearance fees of perishabled ARV drugs for HHS treatment partners in Nigeria including University of Maryland, Harvard University SPH, Columbia University SPH, and Catholic Relief Services. In COP08 a larger portion of the ARVs will be procured through SCMS and preclearance charges will be handled by that organization.

Table 3.3.11: Program Planning Overview Program Area: HIV/AIDS Treatment/ARV Services Budget Code: HTXS Program Area Code: 11 Total Planned Funding for Program Area: $ 59,708,645.00

Program Area Context:

ART SERVICES PROGRAM AREA CONTEXT

USG Nigeria's strategy for COP 07 HIV treatment builds on COP06 activities and increases access to quality ART services in Nigeria. The six areas of strategic focus during COP07 are: (1) further harmonization and standardization of services across partners and with the Government of Nigeria (GON); (2) further resource leveraging with other donor organizations; (3) actualizing tiered networks of care that employ strategies such as up referral and regional training for sophisticated clinical and laboratory procedures and down referral for maintenance of therapy across multiple facilities; (4) site expansion in current states and geographic expansion into new states with an emphasis on supporting more secondary and primary facilities; (5) further developing comprehensive HIV treatment and care systems by utilizing PMTCT, TB/HIV, VCT, and Basic Care and Support services for early site initiation with the goal of later providing ART services at those sites; and (6) recruiting new ART partners through APS and RFA mechanisms.

UNAIDS estimates that approximately 2.9 million Nigerians are living with HIV and only 7% of those who urgently need ART are receiving it. The National ART program, like almost all health programs in the country, is limited by general country infrastructure deficiencies, a weak drug management system, challenging coordination, and lack of a comprehensive information management system. Other obstacles to program success include stigma and discrimination against PLWHA and poor treatment literacy as well as inadequate community mobilization and participation in treatment programs. In the last two years, many of these barriers have been overcome through renovating physical infrastructure, improving laboratory support systems, ensuring community involvement and ownership of programs, and coordinating commodities management towards a unified system for the USG partners. The USG team and our Implementing Partners (IPs) work at all levels of government to improve ARV policies and service implementation. We are an active part of the National ART Committee which is responsible for producing the National ARV Guidelines and have an active role on the Expanded Theme Group and the Donor Coordination Group, both of which focus on harmonization and coordination of HIV services. The success of these efforts has resulted in rapid increases in the number of individuals receiving high quality ARV services in the country.

Five Implementing Partners (IPs) and the U.S Department of Defense (DoD) provide direct support for HIV/AIDS treatment services in Nigeria. Our IPs in this area are Catholic Relief Services (CRS)/AIDSRelief, Columbia University (CU)/ICAP, Harvard School of Public Health (HSPH)/APIN+, Family Health International (FHI)/GHAIN, and the University of Maryland, Institute of Human Virology (IHV)/ACTION. Through USAID's Annual Program Statement (APS) and CDC's RFA's new, local treatment partners will be identified as a COP07 priority activity.

As of July 31, 2006, PEPFAR was providing direct ART therapy for 46,546 patients. This is up from 38,754 in March 2006, and 18,885 from the 2005 annual report. The USG team estimates that COP06 treatment targets will be achieved or exceeded, and that over 76,000 patients will be receiving ARV therapy by the end of the COP06 funding period. Approximately 750 health workers will be trained in ART service delivery. In COP 07, the USG -Nigeria program will continue to support the GON in implementing ART treatment scale-up as outlined in the 5 Year Strategic Plan, with the goal of providing direct ART support to 124,521 individuals maintained on therapy by the end of COP07, including lab support 9,321. The program will expand to a minimum of 20 states from the original 10 and offer ART services in at least 138 sites; this is up from 65 sites in COP 06. In addition, 1,828 additional health care workers will be trained in COP07. These targets are conservative, as they are based strictly on USG funds.

The USG will continue to leverage other available resources in country including GFATM, Clinton Foundation, and the World Bank to exceed these targets. First line drugs and existing site infrastructure were leveraged in COP05/06, yielding an increase in our overall achievable treatment targets by several

thousand. Currently, several partners receive some first line regimens from the GON. The USG team focused on further leveraging GFATM funds for the upcoming Round 5 grant, with promising recent developments. These include serving on the executive committee of the Country Coordination Mechanism, increased collaboration on implementation, more commodities leveraging, several IP's becoming involved in GFATM Round 5 implementation, and at least two IPs (FHI-GHAIN and JSI-Deliver) being sub-recipients for the award. These leveraged resources result in cost savings that will be used to increase targets and could result in as many as 150,000 people on ART in Nigeria by the end of the COP07 period as well as making a stride towards sustainability of the GON program. This will position Nigeria to achieve the out year target of 350,000 individuals on ART.

Our strategy continues to build on the network of care model in COP07 by actualizing networks through the provision of ART at secondary and primary centers in the geographic areas surrounding existing tertiary and experienced secondary care facilities. In COP06, each treatment partner recruited a network coordinator. This is complemented by two USG staff who focus on developing networks of care through geographic mapping, defining referral protocols within and across partners, and promoting activities that rely on efficient leveraging of services across sites. COP07 emphasizes down referral from saturated tertiary and secondary level facilities for therapy maintenance. To ensure effective and efficient service, the USG will work with the GON to develop and implement acceptable standards of service at the various levels of care. Strong and clear linkages will be strengthened, with PMTCT, OVC, TB and care, using those both as entry points to treatment but also as assess to other support services in the community with the overarching goal of providing comprehensive HIV treatment and care services.

The USG and its partners will adhere to protocols and use ART approved by the GON, and will continue to collaborate on revising and updating treatment guidelines and drug policies. As recruiting and keeping clinicians at primary care sites has been a challenge, the USG has opened a dialog with the GON about engaging Community Health Extension Workers (CHEWS) and nurses for ART maintenance using standing orders. Since adherence remains the cornerstone of treatment programming in Nigeria, for COP07, the USG will continue to explore appropriate adherence models that demonstrate best practices in different treatment and community settings. We will support the GON in developing a national adherence and treatment literacy program.

Given the rapid expansion of activities, the USG is instituting multidisciplinary site monitoring teams that include GON participation to assess progress of both existing and new sites. These visits should improve harmonization and standardization of service delivery, and provide the USG team important programmatic information for decision-making.

The Clinical Working Group established by the USG in November 2005 continues to focus on issues relating to the quality of clinical services, such as the non-routine use of viral load, adherence modalities, quality improvement issues, and clinical program assessment activities. Taken in total, these activities represent and extension of existing services and a strategic focus that promotes continued expansion while improving service quality at the site and programmatic levels.

Program Area Target: Number of service outlets providing antiretroviral therapy 138 Number of individuals who ever received antiretroviral therapy by the end of 135,460 the reporting period Number of individuals receiving antiretroviral therapy by the end of the 124,521 reporting period Number of individuals newly initiating antiretroviral therapy during the 53,322 reporting period Total number of health workers trained to deliver ART services, according to 1,828 national and/or international standards

Table 3.3.11:

ACTIVITY DESCRIPTION: This HTXS activity relates directly to all HHS Nigeria ART COP07 activities (see ID references in the narrative).

To support and enhance the USG Nigeria ARV services program, the USG team through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria has two full time staff positions planned for ART Services that will focus on supporting implementing partner ART issues. The budget includes two FSN salaries, ICASS and CSCS charges related to these staff positions, funding for (limited) international and required domestic travel, training funds and allocated minor support costs. The funds planned in this activity also include HHS/CDC HQ Technical Assistance travel for five weeks of in-country support by an ART specialist.

These HHS/CDC ART staff positions will work in coordination with the USAID ART staff (#6782) and directly provide quality assurance and program monitoring to HHS supported implementing partners including: University of Maryland-ACTION (#6766), Harvard SPH-APIN (#6715), Columbia University-ICAP (#6690), Catholic Relief Services-AIDSRelief (#6678), and a partner to be determined by an RFA in the last quarter of 2006. The HHS/CDC staff will also assist USAID staff in joint monitoring visits of Family Health International-GHAIN (#6703) and a USAID APS partner (#6762) for COP06 to be selected. USAID and CDC ART staff will provide assistance as needed to the U.S. Department of Defense (#6798) program with the Nigerian Ministry of Defense.

HHS/CDC and USAID ART staff will provide technical support and capacity development to new partners undertaking ART activities through the New Partner Initiative as well as provide support to the Government of Nigeria at the National and State levels to promote Nigeria National ART guidelines. It is estimated that the ART staff under this activity will provide monitoring and support to over 80 clinical sites in COP07.

CDC will also facilitate the preclearance process of perishable supplies entering Nigeria through diplomatic shipments for PEPFAR implementing partners. This function is expected to transition to SCMS in COP08.

ACTIVITY DESCRIPTION: This HLAB activity relates directly to all Nigeria LAB COP07 activities (see ID references in narrative below).

To support the USG Nigeria team laboratory program, the HHS/CDC Global AIDS Program (GAP) Office in Nigeria has five full time staff positions (one US Direct Hire, one FSN senior laboratory scientist, three FSN laboratory systems specialists focused on HIV) to support the Laboratory Infrastructure program area. A sixth FSN laboratory systems specialist will be hired in 2007 to focus on TB/HIV activities. The budget includes one USDH and five FSN salaries, ICASS and CSCS charges related to these staff positions, funding for (limited) international and required domestic travel, training funds and allocated minor support costs. The funds planned in this activity also include HHS/CDC GAP HQ Technical Assistance travel for six weeks of in-country support by laboratory program area specialists. Funds will also support the outfitting of a small lab training room (with basic equipment) within the CDC-Nigeria offices. This supplemental training and lab project staging space is necessary given the lack of an HIV reference lab in Nigeria and limited lab training space in Abuja, Nigeria.

These HHS/CDC six staff members will work in coordination with the USAID/DOD ART and lab staff. The HHS/CDC Nigeria Lab Scientist (USDH) will take the USG Team Lead for laboratory issues and directly provide quality assurance and programmatic monitoring to HHS/USAID supported implementing partners lab activities including: University of Maryland-ACTION (#6767), Family Health International-GHAIN (#6709), Harvard SPH-APIN (#6716), Catholic Relief Services-AIDSRelief (#6680), Columbia University SPH-ICAP (#6693) and two new COP07 local treatment partners to be selected (#9659 & #9660) and an APS (#6763). Laboratory Management staff will also coordinate the technical services of contracted laboratory consultants CLSI (#9845), ASCP (#9846) and ASM (#9847).

As part of the USG Nigeria team, HHS/CDC Nigeria laboratory staff will also identify potential local partners for capacity development and entry into the PEPFAR ART program in COP07 as well as provide support to the Government of Nigeria at the national and state levels to promote Nigeria National ART laboratory quality assurance guidelines. The HHS/CDC Nigeria laboratory staff will also be significantly involved across the areas of PMTCT, Counseling and Testing, TB/HIV, Safe Blood and Safe Injection where laboratory issues arise.

CDC will also facilitate the preclearance process of perishable lab supplies entering Nigeria through diplomatic shipments for PEPFAR implementing partners. This function is expected to transition to SCMS in COP08.

ACTIVITY DESCRIPTION The USG team, through the HHS/CDC Global AIDS Program (GAP) Office in Nigeria has seven full time staff positions planned for the Strategic Information (SI) program area. This includes a Public Health Informatics Fellow from CDC, two HIV Surveillance Officers, and 4 Monitoring and Evaluation Officers. The budget includes salary and expenses for the fellow and six FSN salaries, ICASS and CSCS charges related to these staff positions, funding for (limited) international and required domestic travel, training funds and allocated minor support costs. The funds planned in this activity also include HHS/CDC GAP HQ Technical Assistance travel for six weeks of in-country support by SI program area specialists.

These seven staff members will work in coordination with the USAID Strategic Information staff members who will have the USG Nigeria Team lead for SI issues and directly provide joint quality assurance/quality improvement (QA/QI) strategies and programmatic monitoring to HHS and USAID supported implementing partners. The SI team, while developing and updating the USG database will provide oversight function and technical support to EP partners and GON as well as strengthening their M&E systems through feedback and capacity building.

HHS/CDC GAP Nigeria Laboratory and SI staff will also provide technical assistance to the Nigerian Federal Ministry of Health (FMOH) to develop local capacity for SI and to plan and conduct the bi-annual HIV sero-prevalence sentinel survey during FY07. The team will also provide technical assistance to FMOH for the National HIV/AIDS and Reproductive Health survey (NARHS+), which is a nationally representative AIDS Indicator Survey with a bio-marker. In both national surveys the team will assist in the development of survey instruments including survey protocols and questionnaire, training of field staff, field supervision, coordination meetings, quality assurance and data management. In addition to these and in collaboration with the USAID SI staff, a facility survey is also planned for FY 07.

HHS/CDC-Nigeria through the SI team will coordinate the efforts of all treatment partners to address two important areas: 1) the assessment of treatment failure through the Targeted Evaluation Group (TEG), a continuing monitoring activity from COP 06 that examines virologic and immunologic responses by type of ARV regimen, adherence, treatment venue, delivery, and demographics; (protocols to be defined with the TEG working group at OGAC) and 2) the continued implementation of the HIVQUAL quality improvement project (initially funded in COP06). The HIVQUAL activity involves building capacity in performance measurement, quality improvement, and infrastructure development at the facility level. In addition, evaluation staff will coordinate a TB/HIV survey to estimate the rate of co-infection and to assess the prevalence of drug resistant tuberculosis in patients attending TB/HIV clinics in Nigeria. The three projects, albeit through different approaches, seek to improve the quality of USG-sponsored HIV care programs, while ensuring adequate use of resources, reducing harm, and reducing the emergence of resistant strains of HIV that may accompany non-adherence.

Contribution to overall program area:

SI activities will directly ensure generation of quality data to measure EP program achievements, performance towards set targets as well as accountability of resources. These SI activities will build the capacity of at least 108 staff of EP partners and the federal and state GON staff, and provide TA to at least 46 organizations.

Based on interagency discussions, the total budget is itemized in the following categories:

$1,500,000 - ANC Survey $1,000,000 - Targeted Evaluation Group $ 600,000 - Strategic Information Staffing $200,000 - TB/HIV Survey $50,000 - Technical Assistance

Funding for SI related equiment and supplies in the amount of $1,000,000 has be placed under SCMS SI for procurement purposes.

ACTIVITY DESCRIPTION: This is a new activity to develop a longterm fellowship program for health care workers in Nigeria to provide sustainability and surge capacity to the government of Nigeria at the state and national levels. The program will be based within the Federal Ministry of Health and will train junior level professionals (physicians, laboratorians) from the state and federal ministries of health. The fellowship program will be a two-year in-service training program in applied epidemiology and public health laboratory practice. The applied epidemiology fellowship program for physicians will serve to link their medical background to the public health needs at the local level specific to HIV/AIDS. They will develop skills that can be applied in their positions at the state and national government levels, thereby furthering the government's capacity in areas such as identifying and interpreting prevalence rates in different populations including most at risk populations (MARPs), evaluating prevention intervention strategies, identifying/quantifying causes of loss-to-follow up, developing and evaluating monitoring systems, and developing referral networks. The public health laboratory fellowship program for laboratorians will serve to link their laboratory background to the public health needs at the local level specific to HIV/AIDS. They will develop skills that can be applied in their positions at the state and national government levels, thereby furthering the government's capacity in areas such as appropriate scale up of HIV diagnostics (for example training of nonlaboratorians to conduct rapid HIV testing), scale up of early infant diagnosis, appropriate scale up and application of resistance testing, and identifying/addressing notification requirements for laboratories with regard to MDR/XDR. The fellows will develop into leaders in public health in Nigeria, and in addition to their applied work they will be expected to organize or facilitate public health training courses for their colleagues in the government and/or at the local level. While the fellows will train in applied epidemiology related to other public health priorities in Nigeria as well, PEPFER funds will be used to develop a specific focus on HIV/AIDS activities within the fellowship program. With the graduation of fellows and their return to the public sector, the program will develop a self sustaining institutionalized capacity to train public health leaders in field epidemiology and field-oriented public health laboratory practice. Graduates of the program will serve as mentors to new trainees and will also present lectures to trainees during didactic portions of the program. As fellows are trained through conducting activities in the field, the program will provide epidemiological services to the public health system at national, zonal, state, and local levels which will serve to address gaps in the government's ability to respond to the HIV/AIDS epidemic. South-south collaboration will be used to link fellows to applied public health training programs in other countries, thereby utilizing lessons learned in similar settings.

CONTRIBUTIONS TO OVERALL PROGRAM AREA The curriculum will lead to capacity development at the national, state, and local level and will ensure sustainability through the involvement of graduates in the program. Sustainability will also be ensured by placing graduates back into their positions with the state and national ministries of health.

LINKS TO OTHER ACTIVITIES C&T, ART Services, ART Lab, Basic C&S, VCT, PMTCT, TB/HIV, OVC and Other Prevention

KEY LEGISLATIVE ISSUES ADDRESSED None

EMPHASIS AREAS The major emphasis area for this activity is "Training" as capacity development for sustainability is a key focus. Minor emphasis areas include "developing a training curriculum and modules" and provision of additional "training resources" for trainers and trainees. "Infrastructure development" is also a minor emphasis as the capacity of the ministry of health is enhanced through the fellows.

ACTIVITY DESCRIPTION: This funding completes the CDC M&S budget which is fully described in activity #6794 (CDC Core Funds). A repeat of the CDC M&S narrative is below.

The USG Nigeria team's M&S goal, through the HHS/CDC office in Nigeria, is to have sufficient staff for COP07 to provide more technical and programmatic oversight and assistance to all implementing partners in Nigeria. To achieve this goal, the CDC Global AIDS Program (GAP) Office in Nigeria has planned for full staffing at 59 positions in FY2007, an increase of 20 technical and administrative support staff (see USG Nigeria Staff Matrix COP07). Presently 38 of the 39 approved COP06 positions have been filled as CDC GAP Nigeria has completed a major recruiting initiative over the last 12 months.

The COP07 staffing plan includes 7 USDH that are comprised of the Chief of Party, Deputy Director, Associate Director for Epidemiology & Clinical Programs, Associate Director for Laboratory Science, Associate Director for Management and Operations, Associate Director for Program Monitoring, and Associate Director for a USG PEPFAR field office in Lagos. The Lagos PEPFAR Field Office, while initially staffed and funded by HHS/CDC will support the extensive USG PEPFAR program in southern Nigeria. Although approval for 2 new USDH positions is sought in COP07, it is not expected that these USDH positions will be filled until Q4 FY07 or Q1 of FY08 due to the process for FTE approval at HHS and the timeline for recruitment, selection and relocation. A further breakdown of total staff requested includes 25 FSN technical staff (funded under specific program areas), 2 contractors under CDC fellowship programs, and 25 support staff including 12 administrative staff, 11 drivers, and 2 IT technicians that are all included under M&S. In the attached supporting documents a full USG PEPFAR Nigeria organizational chart is attached. The specific disciplines of technical staff were determined through an interagency staffing process that allows for complementary staffing across agencies.

M&S costs are inclusive of rent for offices and warehouse space, utilities, office operational costs, M&S specific equipment, M&S specific staff inclusive of all associated costs, travel for M&S staff, training for M&S staff, general ICASS charges, ICASS and CSCS for M&S staff, relocation costs of 2 USDH M&S positions expected in FY07, residential leases and post allowance for 5 USDH M&S positions, security services for offices/warehouse, 3 new vehicles for increased CDC Nigeria technical staff field support, and increased communications costs related to staff growth.

The CDC M&S budget in COP07 supports the USG interagency team process of providing technical assistance and monitoring of PEPFAR activities across a significant array of implementing partners in the Nigeria, which is the second largest PEPFAR country based on established 2009 end targets. Direct country project officer oversight at CDC is in place for four of the six existing Nigeria ARV treatment partners (Harvard University SPH-APIN, University of Maryland-ACTION, Columbia University-ICAP and Catholic Relief Services-AIDSRelief). Additionally, CDC has seven other cooperative agreements supporting a broad range of implementing partner activities such as laboratory, safe blood, TB/HIV and PMTCT.

Funding for M&S related equiment and supplies in the amount of $900,000 has be placed under SCMS M&S for procurement purposes.