NEEDS UPDATED NARRATIVE FOR PLUS-UP

ACTIVITY DESCRIPTION This activity also relates to activities in ARV Services (#6798), Laboratory Infrastructure (#6799), Care and Support (#6802), OVC (#6808), Safe Blood (#6805), TB/HIV (#6795) and Strategic Information (#6800).

The Nigerian Ministry of Defense - US Department of Defense (NMOD-DOD) HIV partnership enters its third year in implementing PEPFAR activities. The US Military HIV Research Program (USMHRP), under the DOD, directly implements with its counterpart, the Nigerian Military. Implementation in this manner ensures direct capacity building within an Agency of the Federal Government of Nigeria.

The Minister of State for Defence (MOSD) has directed the Emergency Plan Implementation Committee (EPIC) to harmonize with all other partners and funding streams of the Nigerian Military to ensure complete synergy among programs and the coordinated/complementary use of resources.

COP 2005 PEPFAR funding supported the opening of four facilities. During 2006, the partnership is commencing activities at three facilities. COP 2007 plans expansion to seven new facilities: (Naval Medical Centre (Warri), Military Hospital (Benin), 355 Nigerian Air Force Hospital (Jos), 82 Division Nigerian Army Hospital, (Enugu), Military Hospital (Port Harcourt), 2 Division Nigerian Army Hospital (Ibadan), and the Military Hospital (Maiduguri).

Under this submission, DoD will provide a free comprehensive prevention of mother to child transmission (PMTCT) program, which will follow the national guidelines, in a total of 14 sites and communities.

A family-centered network approach will be adopted and "opt out" counseling and testing will be provided to pregnant women presenting for antenatal services. Testing will be done following the interim National testing algorithm with same day results. Post test counseling will include prevention counseling for both HIV+ and HIV- women. A total of 4,800 women will be counseled, tested and receive their results. Partner testing will be promoted. HIV testing will be offered to all women of HIV unknown status presenting for labor and delivery.

In accordance with WHO guidelines a full course of ARV prophylaxis will be provided to approximately 270 HIV+ women. ARV-eligible women will be referred to ART sites for treatment and monitoring. ARV prophylaxis will include AZT at 28 weeks and Single dose Nevirapine (sdNVP) in Labor. All infants born to HIV+ women will be provided with sd NVP at birth and AZT during the first 6 weeks.

Infant feeding education and counseling will begin in the antenatal period in accordance with National guidelines, accompanied by appropriate preventive messages to all pregnant women and family members. After delivery, mothers and infants will be followed up to monitor mother's health and to support the mother's compliance of her infant feeding option as well as to provide nutritional support for both. Infant diagnosis will be by referral to a PEPFAR DNA PCR site using the newly introduced dried blood spot (DBS) collection technique.

In support of its commitment to build capacity and long-term sustainability in the NMoD, formal training for an additional 63 staff, in conjunction with other partners, will continue at all 14 sites, covering all staff involved in the PMTCT program. This training will be done in line with the National PMTCT training curriculum.

By training uniformed members and civilian employees at all levels that are invested in a career track in the Government of Nigeria, this Program fosters a generation of skilled workers who are more likely to remain within the military. As these employees are promoted, individuals not only acquire technical skills, but also gain management and oversight capacity fulfilling PEPFAR goals for independent and sustainable programs.

Monitoring and evaluation of service quality, together with a formal quality improvement

mechanism, which includes regular site visits by the DoD/NMoD and appropriate partners, are essential components of this program.

This program fully adheres to USG policies and acquisition regulations, minimizes indirect costs to accomplish the capacity building described above. International and local organizations synergize with the Nigerian Ministry of Defense to identify best practices and implement evidence based interventions in a sustainable manner. The program design ensures continued USG visibility and accountability at all levels of implementation.

By the end of COP07, the DoD will support 14 NMoD sites in Benin, Benue, Borno, Cross Rivers, Delta, Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, and Rivers (11 states and FCT).

CONTRIBUTION TO OVERALL PROGRAM AREA The DoD PMTCT program will provide HIV counseling, testing and results to 4,800 pregnant women and provide ARV prophylaxis to 270 pregnant women. This contributes to the goal of preventing new HIV infections in Nigeria. The PMTCT services identify HIV+ women who may need HAART for their own health thus contributing to the care and treatment goals in Nigeria.

LINKS TO OTHER ACTIVITIES This activity is linked to other program areas, in particular, ARV Services (#6798), Laboratory Infrastructure (#6799), Care and Support (#6802), OVC (#6808), Safe Blood (#6805), TB/HIV (#6795) and Strategic Information (#6800). Pregnant women who present for C&T services will be provided with information about the PMTCT program and referred accordingly. ART treatment services for infants and mothers will be provided through ART Services. Basic pediatric care supports, including TB care, are provided for infants and children through our OVC activities.

POPULATIONS BEING TARGETED This activity targets military personnel, civilian employees, dependents and the general population in the communities surrounding 14 sites and, in particular, pregnant women and girls, infants, partners and family members.

KEY LEGISLATIVE ISSUES This activity will address gender equity in HIV/AIDS programs, by specifically targeting pregnant women and girls for testing, counseling and treatment, male norms and behaviors, through the encouragement of partner notification and on bringing other family members for counseling and testing.

EMPHASIS AREAS This activity has a major emphasis on building local organizational capacity and minor emphases on community mobilization, logistics, policy and guidelines and training.

ACTIVITY DESCRIPTION This activity relates to activities in PMTCT 6801, Condom and Other Prevention 6804, Counseling & Testing 6796, Care & Support 6802, TB/HIV 6795, OVC 6808, ARV drugs 6797, ARV services 6798, 6708 and Strategic Information 6800.

The Nigerian Military provides care to its service members and the surrounding civilian community (over 80% of the Military's patient load is civilian). The partnership will extend free access to prevention services to seven additional military facilities and communities: Naval Medical Centre (Warri), Military Hospital (Benin), 355 Nigerian Air Force Hospital (Jos), 82 Division Nigerian Army Hospital, (Enugu), Military Hospital (Port Harcourt), 2 Division Nigerian Army Hospital (Ibadan), and the Military Hospital (Maiduguri).

Key prevention activities will include general awareness campaigns, peer education, interpersonal communication activities, production and dissemination of appropriate Information, Education and Communication (IEC) materials and community mobilization activities to encourage and reinforce partner reduction and be faithful messaging. 250 NMOD personnel will be trained as trainers of trainers and as unit-level trainers.

Behavior change interventions within the military population will seek to delay sexual initiation, reduce multiple and concurrent partnerships, and increase perception regarding risky behavior. Building on the overall policies and activities of partners, the DoD, working with and through other service providers, will expand efforts to reach adult men as a key bridge from high-risk groups to the general population, with programs that promote marital fidelity, address male norms and behaviors that put both men and women at risk, and increase risk perception with appropriate linkages to activities in the Other Prevention program area for individuals engaging in high-risk behavior. A total of 15,000 individuals in the Nigerian military will be reached with messages that promote HIV/AIDS prevention through abstinence and/or being faithful, and a further 6,000 individuals will be reached indirectly.

To better address the vulnerability of girls and young women within the general population and in support of other partners, DoD activities may include addressing cross-generational sex issues, transactional sex, skills-based HIV education for girls and young women as well as efforts to engage "influencers" of youth: parents, teachers, religious and community leaders. Through this activity, an estimated 5,000 individuals will be reached with these prevention messages.

The Nigerian Ministry of Defense - US Department of Defense (NMOD-DOD) HIV partnership enters its third year in implementing PEPFAR activities. The US Military HIV Research Program (USMHRP), under the DOD, directly implements with its counterpart, the Nigerian Military. Implementation in this manner ensures direct capacity building within an agency of the Federal Government of Nigeria. Through this partnership, the impact of this program in Nigeria is profound on several levels. This includes developing a strong USG relationship with another branch of the Nigerian Government, building capacity of the indigenous partner through joint implementation of activities and offering a cost-effective model for implementation through a direct USG-GON collaboration.

A major focus of COP07 is to work with other partners and leverage resources, the DoD will support existing military organizations, such as the AFPAC, military community-based organizations, such as Officers' Wives Clubs, and other partners, such as Society for Family Health (SFH) in the development and implementation of their HIV policies and strategic plans.

Monitoring and evaluation of service quality, together with a formal quality improvement mechanism, which includes regular site and program visits by the DoD/NMoD and appropriate partners, are essential components of this activity.

By the end of COP07, DoD will support 14 NMoD sites in Benin, Benue, Borno, Cross River, Delta, Enugu, the Federal Capital Territory (FCT), Kaduna, Lagos, Oyo, Plateau, and Rivers (11 states and FCT).

CONTRIBUTION TO OVERALL PROGRAM In conjunction with the other DoD activities, and those of other partners, in COP07, this

activity will contribute to the provision of a comprehensive HIV and AIDS prevention package for the military population, civilian employees, their dependents and the communities surrounding military sites. This program will, therefore, contribute to the PEPFAR overall aim of preventing further infections and reducing HIV infection rates in Nigeria.

LINKS TO OTHER ACTIVITIES These activities will be linked to condom and Other Prevention Activities 6804, VCT 6796 and Care and Support 6802, and, indirectly, to all other program areas, including those of the GoN and other USG partners.

POPULATIONS TARGETED This activity targets the military, civilian employees, dependents, and the communities surrounding military sites, in particular, PLWHAs, young adults, youths generally and, in particular, young women and girls, out of school youths, their parents and other significant adults, such as religious leaders.

KEY LEGISLATIVE ISSUES Key legislative issues addressed by this activity are male norms and behaviors, gender- gender equity in programming through interventions targeting youths particularly young girls, boys, service men and women..

EMPHASIS AREAS This activity includes major emphasis on information education and communication and minor emphasis on local organization capacity development, community mobilization, links with other sectors and training.

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

ACTIVITY DESCRIPTION The activitiy is linked to laboratory infrastructure (6799) and Medical Transmission Injection Safety (3.3.04).

The Nigerian Ministry of Defense - US Department of Defense (NMOD-DOD) HIV partnership enters its third year in implementing PEPFAR activities. The US Military HIV Research Program (USMHRP), under the DOD, directly implements with its counterpart, the Nigerian Military. Implementation in this manner ensures direct capacity building within an Agency of the Federal Government of Nigeria. Through this partnership, the impact of this program in Nigeria is profound on multiple levels- developing a strong USG relationship with another branch of the Nigerian Government; building capacity of the indigenous partner through joint implementation of activities; and offering a cost effective model for implementation through a direct USG-GON collaboration, and supporting both the military and civilian communities, as 80% of patients under ART at military facilities are civilian

The DoD will, in 2007, provide support to NMoD to reduce HIV transmission through emergency blood transfusion at 7 existing and 7 additional NMoD military healthcare facilities. It is anticipated that 5,000 units of blood will be screened in this activity. This activity will support capacity development for Blood safety (training and equipments), screening for HIV, universal precautions and good laboratory practice, waste management and QA/QC for HIV serologic testing.

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

In line with the GoN National training guideline, and curriculum for HIV testing for blood transfusion safety, DOD , will train 210 staff on all aspects of blood safety and, at time of donation, will provide prevention messaging, encourage blood donors to seek voluntary counseling and testing, and to join a formal donor recruitment program. The site trainings will be conducted under the supervision of DOD staff.

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

Screening for HIV will involve the use of Determine Test kits as the sole test for every unit of blood. Expectedly, a total number of 5,000 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, DOD will institute an aggressive QA/QC program that involves on-site quarterly monitoring and retraining; and proficiency in rapid HIV testing. The DoD will implement monitoring and evaluation of service quality, together with a formal quality improvement mechanism, which includes regular site visits by the DoD/NMoD consultant teams. These teams, made up of Nigerian officers and appropriate partners will visit each site quarterly (more frequently during start up). External quality assurance will be provided by USMHRP US and African-based laboratorians and consultants, and is an essential component of this program. Safe Blood for Africa and NBTS visits will also be

coordinated.

This activity will provide support for 14 Service outlets, train 210 Individuals in counseling and testing, blood safety protocol, and provide HIV screening for an estimated 5000 individuals.

Contribution to Overall Program Area [Target: up to 1,500 characters] This activity contributes to the USG target of preventing 1,145,545 new infections by February 28, 2009 through prevention of medical transmission of HIV and ensuring a safe, screened blood supply is available for emergency blood transfusions. This activity will help establish mechanisms for referral to tertiary centers for blood banking services, while providing the infrastructure and training to NMoD health facilities to establish high quality blood safety practices.

LINKS TO OTHER ACTIVITIES The primary link is to laboratory infrastructure 6799 to strengthen the systems and testing conducted on all emergency blood samples by the NMoD. The DoD will strengthen the link with other activities to ensure that these activities benefit from a screened, safe blood supply. NMoD laboratories will help to provide a safe emergency blood supply to the communities served.

POPULATIONS TARGETED This activity targets the military, civilian employees, dependents and the general population, in particular health care providers, pregnant women, children, and hospital patients who require emergency blood and blood products.

KEY LEGISLATIVE ISSUES ADDRESSED This activity will address male norms and behaviors, by encouraging counseling and providing prevention messaging, and gender inequalities, by reduction in HIV transmission and new infections and maternal and infant mortality.

EMPHASIS AREAS This activity includes major emphasis on training and minor emphasis on infrastructure development, quality assurance/improvement, commodity procurement and logistics.

ACTIVITY DESCRIPTION This activity also relates to activities in ARV services (#6798) and (#6807), PMTCT (#6801), Care and Support (#6802) and VCT (#6796).

The Nigerian Ministry of Defense - US Department of Defense (NMOD-DOD) HIV partnership enters its third year in implementing PEPFAR activities. The US Military HIV Research Program (USMHRP), under the DOD, directly implements with its counterpart, the Nigerian Military. Implementation in this manner ensures direct capacity building within an Agency of the Federal Government of Nigeria.

The Nigerian Military provides care to its service members and the surrounding civilian community (over 80% of the Military's patient load is civilian). The partnership will extend free access to prevention services to seven additional military sites. 2005 saw the opening of four facilities at Defence Headquarters Medical Center (Abuja), 44 Nigerian Army Reference Hospital (Kaduna), Navy Hospital (Ojo in Lagos), and 445 Nigerian Air Force Hospital (Ikeja in Lagos). During 2006, the DoD-NMoD partnership is commencing activities at three facilities: 45 Nigerian Air Force Hospital (Makurdi), 3 Division Nigerian Army Hospital (Jos), and Navy Medical Centre (Calabar). The 2007 budget will see expansion to seven additional facilities and communities. (Naval Medical Centre (Warri), Military Hospital (Benin), 355 Nigerian Air Force Hospital (Jos), 82 Division Nigerian Army Hospital, (Enugu), Military Hospital (Port Harcourt), 2 Division Nigerian Army Hospital (Ibadan), and the Military Hospital (Maiduguri).

In addition, in partnership with other service providers, such as the Armed Forces Program on AIDS Control (AFPAC) and the Government of Nigeria (GoN) at federal, state and Local Government Area (LGA) levels, and dependent on funding levels, DoD may extend its prevention services to a wider, national-level military and civilian population, with targeted messaging in relation to prevalence rate and demographics.

This activity which will strengthen HIV prevention throughout the Nigerian Department of Defense will include activities geared to offering high quality STI services including diagnosis and treatment for the military personnel who belong to the most at risk population. These services will be offered at 14 NMOD sites by the end of FY07 in Benin, Benue, Borno, Cross Rivers, Delta, Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, and Rivers, (11 states and FCT). These sites will also focus on STIs to determine the prevalence of STIs in the military and make recommendations for the most appropriate approach to treatment of STIs in the Nigerian military. The involvement of people living with HIV/AIDS (PLWHAs) in the areas of peer education, counseling, care and support will also be a key focus activity. Prevention programming opportunities for Uniform services will also include interventions in or nearby bars where they recreate.

The DoD will train an additional 100 healthcare workers to be able to deliver behavioral change messages to all seeking services at the 14 NMOD sites. A proportion of health workers will be trained to be able to perform brief screening for HIV transmission risk behaviors, communicate and reinforce prevention messages and discuss sexual and drug abusive behavior. Existing liaisons with the Ministry of Health and the National Committee on AIDS (NACA) will ensure high quality care and training in STI /HIV; prevention education for NMOD staff health personnel assigned at the military health facilities.

During this submission, and in conjunction with other partners, work with high risk youth will continue in gender-sensitive programs aimed at the prevention needs of young, unmarried females and males, including addressing the risk behaviors of multiple partnerships and transactional sex, formal and informal, providing clear messages about safer sex and referral to appropriate reproductive health services. It is expected that this activity will directly reach a target of approximately 80,000 individuals, including recruits at basic training centers, youths, service members and their dependents, and PLWHA within the surrounding communities by September 2008. A further 2,800 will be reached indirectly.

The USG programmed 34% of its Other Prevention programming to its collaborative program with the Nigerian Ministry of Defense. Programming focuses on teaching the military condom skills and ensuring condom availability complementing other DOD programming on faithfulness and linkages to CT, treatment, care and support, prevention

for HIV+ patients and work with discordant couples through military medical centers. Condom distribution and education services will be incorporated through prevention efforts at the 14 sites, basic training camps, and at NMOD training centers. Condoms and other appropriate materials on HIV transmission risks, prevention of transmission to others, and preventing acquisition of STIs will be provided directly by the DOD, and indirectly through other partners. Prevention activities will be fully integrated into DoD activity locations.

By training 280 uniformed members and civilian employees at all levels who are invested in a career track in the Government of Nigeria, this Program fosters a generation of skilled workers who are more likely to remain within the military. As these employees are promoted, individuals not only acquire technical skills, but also gain management and oversight capacity fulfilling PEPFAR goals for independent and sustainable programs.

This program fully adheres to USG policies and acquisition regulations, minimizes indirect costs to accomplish the capacity building described above. International and local organizations synergize with the NMoD to identify best practices and implement evidence based interventions in a sustainable manner. The program design ensures continued USG visibility and accountability at all levels of implementation

CONTRIBUTION TO OVERALL PROGRAM AREA This activity will contribute to the provision of a comprehensive HIV and AIDS care package for the military population, civilian employees, their dependents and the communities surrounding military sites and will, therefore, contribute to the overall aim of reducing HIV infection rates in Nigeria.

LINKS TO OTHER ACTIVITIES This activity also relates to activities in ARV services (#6798) and (#6807), PMTCT (#6801), Care and Support (#6802) and VCT (#6796) The DoD will establish referral linkages with community-based programs and other implementing partners to ensure that HIV+ individuals have access to the full range of appropriate, quality prevention services.

POPULATIONS BEING TARGETED This activity is targeted at the military population, civilian employees, their dependents and the communities surrounding military sites, including men and women of reproductive age, health care workers and community- and faith-based organizations.

KEY LEGISTLATIVE ISSUES These activities will focus on gender issues, including prevailing male norms and behaviors, reducing violence and coercion, and reducing stigma and discrimination.

EMPHASIS AREAS This activity has a major emphasis on training. A minor emphasis is placed on information, education and communication, capacity development, community mobilisation, links with other sectors and establishment of referral linkages and community networks.

ACTIVITY DESCRIPTION DOD palliative care activities link to DOD, PMTCT (#6801), TB/HIV (#6795), OVC (#6808), Voluntary counseling & testing (#6796), ARV Drugs (#6797), ARV services (#6798) activities, with HBC providers and existing CBOs to ensure continuity of basic care and support for all PLWHAs and for community awareness activities.

The Nigerian Ministry of Defense - US Department of Defense (NMOD-DOD) HIV partnership enters its third year in implementing PEPFAR activities. The US Military HIV Research Program (USMHRP), under DOD, directly implements with its counterpart, the Nigerian Military. Implementation in this manner ensures capacity building within an Agency of the Federal Government of Nigeria. Through this partnership, the impact of this program in Nigeria is profound on several levels. This includes developing a strong USG relationship with another branch of the Nigerian Government, building capacity of the indigenous partner through joint implementation of activities and offering a cost effective model for implementation through a direct USG-GON collaboration. .

The Program is governed by a Steering Committee, co-chaired by the Minister of State for Defence (MOSD) and the US Ambassador to Nigeria. Membership on this Committee includes senior representatives of both militaries and includes the Federal Ministry of Health (FMOH) and National Committee on AIDS Control (NACA) representation to participation in the Government of Nigeria HIV harmonization process. Thus, the Program fully adheres to all USG and FMOH national treatment guidelines.

COP 2005 PEPFAR funding supported the initiation of HIV treatment services at four facilities at Defence Headquarters Medical Center (Abuja), 44 Nigerian Army Reference Hospital (Kaduna), Navy Hospital (Ojo in Lagos), 445 Nigerian Air Force Hospital (Ikeja in Lagos). During 2006, the partnership is commencing activities at three facilities: 45 Nigerian Air Force Hospital (Makurdi), 3 Division Nigerian Army Hospital (Jos), and Navy Medical Centre (Calabar). COP 2006 funding is also supporting the NMOD-DOD program in use of the Supply Chain Management Partnership (SCMS) for drug acquisition. COP07 will see expansion to seven additional facilities (Naval Medical Centre (Warri), Military Hospital (Benin), 355 Nigerian Air Force Hospital (Jos), 82 Division Nigerian Army Hospital, (Enugu), Military Hospital (Port Harcourt), 2 Division Nigerian Army Hospital (Ibadan), and the Military Hospital (Maiduguri). At least 80% of the clients accessing services at these military facilities are civilians from surrounding communities making the military program an important member of the FMOH national HIV effort.

In line with National guidelines and protocols, the NMOD/DOD program will support the provision of palliative care services to 14,570 PLWHA and their families in the communities in and around the military sites providing ART. A component of this program will be developing and maintaining links with active community-based organizations, home-based care providers (HBCs) and faith-based organizations (FBOs) that will provide at home follow up of patients attending the ART clinics. DOD will also work with, and support, the NMOD and its partners in further developing internal guidelines, protocols and standard operating procedures (SOPs), using evidence-based interventions, particularly in the area of paediatric care and implementation of a preventive-care-package.

DOD will support the provision of comprehensive clinical care, including OI prophylaxis, diagnosis and treatment as well as pain and symptom management, throughout the full course of the infection at all 14 hospitals. This will be accomplished by: strengthening institutional and health worker capacity with ongoing, in-service training; providing initial training to 56 additional health care workers in palliative care skills as part of and in addition to ART education; increasing the capacity of clinicians to diagnose and manage common OIs; provide psychosocial counseling; strengthening laboratory diagnostic facilities (see DOD lab submission); and improving pharmacy capacity (see DOD ARV drug submission). Facility based care will be enhanced using a network model through trained volunteers, nurses, health workers and family members working together both in the facilities as well as following up patients at home. In its commitment to best practice and evidence-based care, the NMOD/DOD will implement a preventive-care-package for all HIV+ clients which will include nutritional counseling and evaluation using a BMI based method, provision of insect treated nets and water guards as well as cotrimoxazole for patients with low CD4 counts.

As part of overall facility based care and treatment, health care workers who have been trained and have been supporting treatment at facilities operating since 2005 will be sent to new facilities in the initial phases of operation to provide mentoring and continuity of services among military facilities and monitor quality of services. Continued site support will be conducted using these preceptors as a central care/ART QA/QC team as developed over 2006-2007.

Funding under DOD will also support clinical care activities and support the involvement of USG partners and implementing partners (IPs), support groups and community-based workers, and PLWHAs, in promoting improved general care and support; distribution of national educational materials on HIV care and those addressing stigma and discrimination

Monitoring and evaluation of service quality, together with a formal quality improvement mechanism, which includes regular site visits by the NMOD/DOD and appropriate partners, are essential components of this program. Consultant teams will be comprised of trained providers from other Military facilities which have already commenced treatment activities. These consultant visits will occur at least.

This program fully adheres to USG policies and acquisition regulations, minimizes indirect costs to accomplish the capacity building described above. International and local organizations synergize with the Nigerian Ministry of Defense to identify best practices and implement evidence based interventions in a sustainable manner. The program design ensures continued USG visibility and accountability at all levels of implementation.

By the end of COP07, DoD will support 14 NMoD sites in Benin, Benue, Borno, Cross River, Delta, Enugu, the Federal Capital Territory (FCT), Kaduna, Lagos, Oyo, Plateau, and Rivers (11 states and FCT).

CONTRIBUTIONS TO OVERALL PROGRAM AREA The expansion of care and support to an additional 7 communities, supporting 7 existing communities and maintaining links with other partners will provide increased access of such services to currently underserved communities and contribute towards the overall PEPFAR palliative care targets and the 5-year USG plan for Nigeria.

POPULATIONS BEING TARGETED The military, civilian military employees, dependents and the general population surrounding the 14 sites. Focusing on HIV positive adults, including pregnant women, patients co-infected with TB and HIV through seamless integration with PMTCT and TB/HIV program elements.

KEY LEGISLATIVE ISSUES ADDRESSED Targeted community involvement will address gender issues, increase uptake by women and reduce male discriminatory norms. Community level training and involvement in HBC will reduce stigma and discrimination associated with HIV status.

EMPHASIS AREAS The major emphasis will be on community involvement with minor emphasis on training, links with other sectors, food/nutrition, community development, network development, quality assurance and quality improvement.

ACTIVITY DESCRIPTION This activity will also be linked to all appropriate Basic Health Care and Support HBHC(6802) Orphans and Vulnerable Children OVC (6808) Laboratory Infrastructure HLAB (6799) Counseling and Testing HVCT (6796).

COP05 PEPFAR funding supported the opening of four facilities: Defence Headquarters Medical Center (Abuja), 44 Nigerian Army Reference Hospital (Kaduna), Navy Hospital (Ojo, Lagos), 445 Nigerian Air Force Hospital (Ikeja, Lagos). During COP06, the partnership is commencing activities at three facilities: 45 Nigerian Air Force Hospital (Makurdi), 3 Division Nigerian Army Hospital (Jos), and Navy Medical Centre (Calabar). COPO7 plans expansion to seven new facilities (Naval Medical Centre (Warri), Military Hospital (Benin), 355 Nigerian Air Force Hospital (Jos), 82 Division Nigerian Army Hospital, (Enugu), Military Hospital (Port Harcourt), 2 Division Nigerian Army Hospital (Ibadan), and the Military Hospital (Maiduguri). Total of 14 sites are to be used.

Approximately 40-50% of tuberculosis (TB) patients are HIV-infected and, conversely, it is estimated that roughly 20% of HIV-infected patients develop clinically-overt TB. Aggressive detection and treatment of TB is important in order to reduce morbidity and mortality associated with HIV infection. In addition, aggressive HIV counseling and testing of TB patients represents an important public health strategy which will be key in the further identification and treatment of HIV-infected individuals.

The NMOD/DOD partnership will extend free HIV services to include screening for TB among all HIV+ identified in or referred to HIV treatment clinics at the military hospitals. The NMOD/DOD will ensure that all clients accessing ART services are routinely screened by questionnaire for TB, and if clinically indicated, confirmed by 3 sputum smears, fluorescent stain and/or culture (Nationally accepted algorithm). In addition, to improve the detection of military, dependents and surrounding community civilians who are co-infected with TB/HIV, HIV counseling and testing at the TB Units in all the military hospitals will be integrated using an opt out approach. Expansion of TB/HIV services in FY07 will also ensure a close linkage of military implementation to national strategies and programs.

During COP07, it is anticipated that a total of 2914 patients (20% of the estimated 13470 HIV+s screened for TB ) will be diagnosed with active TB and will require TB treatment through the NMOD/DOD program. Patients co-infected with HIV/TB will either be provided with TB treatment at the diagnosing military site or referred to the nearest appropriate public supported Direct Observable Treatment System (DOTS) site. Many military facilities work in conjunction with NGO or FMOH DOTS sites through out the country and have been strengthening these referral mechanisms with support from PEPFAR. At military facilities, TB prophylaxis will be offered to HIV+ patients (1,347) according to individual clinical need and according to national guidelines. The NMOD/DOD partnership will utilize proven adherence strategies for patients on anti-retroviral (ARV) and TB treatment. Community health workers, community support groups and volunteers, including people living with HIV/AIDS (PLWHAs), will be trained locally by clinical staff and supported to assist with patient adherence to ART and TB drugs through a buddy system.

Funding will support training of 42 additional healthcare staff in TB and HIV diagnosis and clinical management to increase detection and referral of TB cases to the TB Unit among their HIV positive patients. Clinicians and laboratory technologists at each HIV clinic and TB Unit of each military hospital will undergo intensive (two week) training organized in collaboration with the FMOH, national TB program and other stakeholder.

Funding will also support improvement in laboratory capacity for TB diagnosis. Laboratory infrastructure and equipment will be upgraded and staff trained in TB screening and diagnosis of patients infected with HIV. This will include but not be limited to biologic hoods, microscopes, staining material, and safety equipment for staff which will complement overall HIV lab improvements under PEPFAR. The NMOD/DOD will link with government and other implementing partners' reference laboratories, such as ACTION (UMD) and the TB reference facility in Zaria for laboratory training, development of SOPs and quality improvement activities ensuring continuity of PEPFAR supported programs . Support to other National Programs, such as the NIAID supported program at the National Institute of Pharmaceutical Research and Development in the form of clinical samples.

Cotrimaxozole Preventive Therapy (CPT) will be provided to eligible TB/HIV patients .Nosocomial transmission of TB to HIV+ patients will be prevented through measures and principles such as basic hygiene , proper disposal of sputum .good cross ventilation at the clinics and provision of face masks etc. Monitoring and evaluation of service quality, together with a formal quality improvement mechanism, which includes regular site visits by the NMOD/DOD and appropriate partners, are essential components of this program. These consultation visits will occur at least quarterly.

This program fully adheres to USG policies and acquisition regulations, minimizes indirect costs to accomplish the capacity building described above. International and local organizations synergize with the Nigerian Ministry of Defense to identify best practices and implement evidence based interventions in a sustainable manner. The program design ensures continued USG visibility and accountability at all levels of implementation. By the end of COP07, the DoD will support 14 NMoD sites in Benin, Benue, Borno, Cross Rivers, Delta, Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, and Rivers (11 states and FCT).

CONTRIBUTIONS TO OVERALL PROGRAM AREAS The provision of DOTS centers on 14 NMoD sites, and the development of links with DOTS centers provided by other partners, will expand access to quality TB services. This improved access will result in higher TB case detection and improved treatment outcomes. Through the provision of services to 2694 TBHIV patients, the DOD will contribute to the emergency plan treatment goals for TB/HIV care in Nigeria

LINKS TO OTHER ACTIVITIES This activity will also be linked to all appropriate Basic Health Care and Support HBHC(6802) Orphans and Vulnerable Children OVC (6808) Laboratory Infrastructure HLAB (6799) Counseling and Testing HVCT (6796) Activities will be linked also to behaviour modification prevention programs(6803) and to strategic information systems (6800)), to improve surveillance and monitoring information, and to inform policy and system strengthening activities .

POPULATIONS BEING TARGETED People in the military personnel, civilian employees, dependents, and the general population of the communities surrounding 14 sites affected by TB/HIV, including orphans and vulnerable children (OVC), PLWHAs and their families. Women, in particular within the age range of 25-44, will be targeted, as there is a higher reported incidence of TB among this group.

KEY LEGISTLATIVE ISSUES ADDRESSED Improved gender balance in programming through prevention, diagnosis and treatment activities targeted at young girls and women, who account for 41% of TB cases in Nigeria and who have limited access to services.

EMPHASIS AREAS This activity includes major emphasis on linkages with other sectors and initiatives and minor emphasis on commodity procurement, quality assurance, capacity building and training.

ACTIVITY DESCRIPTION DoD OVC activities (6808) also relates to PMTCT (6801), VCT (6796), ART Services and Drugs (6798and 6797), and TB/HIV (6795) services.

The Nigerian Ministry of Defense - US Department of Defense (NMOD-DOD) HIV partnership enters its third year in implementing PEPFAR activities. The US Military HIV Research Program (USMHRP), under the DOD, directly implements with its counterpart, the Nigerian Military. Implementation in this manner ensures direct capacity building within an Agency of the Federal Government of Nigeria. Through this partnership, the impact of this program in Nigeria is profound on several levels. -This includes developing a strong USG relationship with another branch of the Nigerian Government, building capacity of the indigenous partner through joint implementation of activities and offering a cost effective model for implementation through a direct USG-GON collaboration. .

The PEPFAR and DOD/USMHRP is an excellent partnership with the MOD and the Nigerian Military. The Program is governed by a Steering Committee, co-chaired by the Minister of State for Defence (MOSD) and the US Ambassador to Nigeria. Membership on this Committee includes senior representatives of both militaries and includes the Federal Ministry of Health (FMOH) and National Committee on AIDS Control (NACA) representation to participation in the Government of Nigeria HIV harmonization process. The Program fully adheres to all USG and FMOH national treatment guidelines. The subordinate committee, called the Emergency Plan Implementation Committee (EPIC), is comprised of Nigerian and US Military members and directs the implementation of the Program through daily communication between Committee members. The MOSD has directed the EPIC to harmonize with all other partners and funding streams of the Nigerian Military to ensure complete synergy among programs and coordinated/complementary use of resources.

COP05 saw the opening of four facilities at Defence Headquarters Medical Center (Abuja), 44 Nigerian Army Reference Hospital (Kaduna), Navy Hospital (Ojo in Lagos), 445 Nigerian Air Force Hospital (Ikeja in Lagos). During COP06, the DoD-NMoD partnership is commencing activities at three facilities: 45 Nigerian Air Force Hospital (Makurdi), 3 Division Nigerian Army Hospital (Jos), and Navy Medical Centre (Calabar). The FY07 budget will see expansion to seven additional facilities (Naval Medical Centre (Warri), Military Hospital (Benin), 355 Nigerian Air Force Hospital (Jos), 82 Division Nigerian Army Hospital, (Enugu), Military Hospital (Port Harcourt), 2 Division Nigerian Army Hospital (Ibadan), and the Military Hospital (Maiduguri). OVC services (6808) will be implemented at these seven new sites.

The DoD OVC activities encompass paediatric basic care and support, pediatric TB/HIV care and community support for OVC in HIV affected families. In COP07, OVC services will increase from 7 to 14 military sites and supporting communities, serving 1,085 orphans and vulnerable children (OVCs) through a network of linked services and in cooperation with other partners, including community- and faith-based organizations, serving these communities.

DoD will provide a basic package of care that includes laboratory diagnosis and monitoring for opportunistic infections (OIs), and drugs for their treatment, to all paediatric HIV+ clients. DoD will provide a family-centered comprehensive package of diagnosis (including TB, malaria and diarrheal diseases), treatment and care services (including Insecticide Treated Mosquito nets, nutritional supplements and water guards) to patients and clients.

DoD will continue to train multi-disciplinary teams in the clinical management of paediatric HIV+ clients, including TB and other opportunistic infections, paediatric counseling and support for treatment adherence. 42 additional healthcare staff and volunteers, including PLWHAs, will be trained to meet the special needs of children and their parents/care givers and provide the support needed at community and family level. This multi-disciplinary approach will minimize losses to follow-up and integrate prevention messaging within the treatment and clinic activities. Further emphasis on providing a seamless service (PMTCT, VCT, ART) and links with other providers, including PEPFAR partners and IPs, to support the provision of a comprehensive range of activities will be a key focus of this activity.

By training uniformed members and civilian employees at all levels that are invested in a

career track in the Government of Nigeria, this Program fosters a generation of skilled workers who are more likely to remain within the military. As these employees are promoted, individuals not only acquire technical skills, but also gain management and oversight capacity fulfilling PEPFAR goals for independent and sustainable programs.

The two Day Centres established in COP06 will continue to be supported and evaluated and an additional centre may be developed or support given to such centres established by other partners within the communities. Services provided will include basic education on hygiene and universal precautions, nutritional advice and support, status disclosure and stigma reduction, and involvement of the extended family in these activities will be encouraged.

Monitoring and evaluation of service quality, together with a formal quality improvement mechanism, which includes regular site visits by the DoD/NMoD and appropriate partners, are essential components of this program. As part of this process, services provided to these children will be monitored by DOD using nationally and PEPFAR approved tools that allows the monitoring of services provided directly by DOD and those provided via referral from DOD to another organization.

By the end of COP07, DOD will support 14 NMoD sites in Benin, Benue, Borno, Cross Rivers, Delta, Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, and Rivers (11 states and FCT).

This program fully adheres to USG policies and acquisition regulations, minimizes indirect costs to accomplish the capacity building described above. International and local organizations synergize with the Nigerian Ministry of Defense to identify best practices and implement evidence based interventions in a sustainable manner. The program design ensures continued USG visibility and accountability at all levels of implementation.

CONTRIBUTION TO OVERALL PROGRAM AREA The inclusion in OVC services, such as nutrition support and special pediatric counseling, will contribute to the comprehensive care of children infected and affected by HIV and AIDS. In addition, by extending these services to 7 additional sites and communities, this activity, and the further development of links with other DOD programs and with other service providers, will contribute to the overall national target of improving care to HIV affected and infected orphans and vulnerable children.

LINKS TO OTHER ACTIVITIES DOD will collaborate with community-based and faith-based organizations in the provision of community and home-based care services to the OVC clients.

POPULATION BEING TARGETED This activity will target Orphans and Vulnerable Children, families affected by HIV/AIDS, caregivers of OVCs and community-based organizations (CBOs and FBOs).

KEY LEGISLATIVE ISSUES ADDRESSED The activity will address gender, such as increasing gender equity in HIV/AIDS programs, and wrap around-issues, such as linking the OVC services with community based organizations that provide services such as life skills improvement, food/nutrition, education, household help and child care.

EMPHASIS AREAS The activity has major emphasis on capacity development and minor emphasis on training, community mobilisation, network development, and food and nutrition support.

ACTIVITY DESCRIPTION This activity also relates to activities in Abstinence/Be Faithful (#6803), Condoms and Other Prevention (#6804), TB/HIV (#6795), OVC (#6808), SI (#6800) and PMTCT (#6801).

COP 05 PEPFAR funding supported the opening of four facilities: Defence Headquarters Medical Center (Abuja), 44 Nigerian Army Reference Hospital (Kaduna), Navy Hospital (Ojo, Lagos), 445 Nigerian Air Force Hospital (Ikeja, Lagos). During COP06, the partnership is commencing activities at three facilities: 45 Nigerian Air Force Hospital (Makurdi), 3 Division Nigerian Army Hospital (Jos), and Navy Medical Centre (Calabar). COP 2007 plans expansion to seven new facilities (Naval Medical Centre (Warri), Military Hospital (Benin), 355 Nigerian Air Force Hospital (Jos), 82 Division Nigerian Army Hospital, (Enugu), Military Hospital (Port Harcourt), 2 Division Nigerian Army Hospital (Ibadan), and the Military Hospital (Maiduguri).

The NMOD/DOD will double the number of NMOD VCT sites supported from 7 to 14, locating these clinics at military hospitals providing HIV care and treatment. In addition, provider initiated counseling and testing will be introduced at all the 14 hospitals' out patient clinics, in patient wards and TB clinics (see TB/HIV narrative under DOD) to improve identification of HIV+ among these populations. Counseling and testing will also be offered at STI, family planning, antenatal, blood donation, and other patient encounter activities. It is anticipated that combined clinical CT and VCT, services will be accessed by 68,500 individuals by September 2008, of whom 67,150 (89%) will receive their results. Through networking and training Local Government Area (LGA) staff (2 per site), a further 7,000 individuals (10 LGAs per DoD site and 50 individuals per site) will access CT services indirectly.

This activity will focus on the delivery of high quality, cost-effective counseling and testing at hospital facilities as the main entry point to a seamless service for individuals, discordant couples, partners and families. VCT services will promote "couple counseling & testing" at the service outlets. In addition, all VCT and other HIV clinical services will link to prevention messaging for HIV+ and HIV- clients supported under AB and Other Prevention entries, to include counseling on partner reduction, prevention-for-positives messaging and condom provision. The integration of CT, treatment and prevention programs will follow a family-centered, community-based approach, including a decentralized, community-based network model in partnership with the GON at all levels, utilizing a nationally accepted testing algorithm. Other partners working either with the military or surrounding communities, such as SFH and small indigenous organizations, will be involved in this approach. Counseling and testing centres will display the national logo in support of the National program and consistent branding.

A unique aspect of the partnership with the Nigerian Military is that ithas a policy of compulsory counseling and testing for specific target populations: military applicants, personnel posted overseas, and those selected for overseas training. (along with prevention messages, pre and post test counseling, features not usually offered until by the NMOD). Pre accession applicant testing will be supported by pushing the testing availability to the most initial point of entry. This provides significant advantages for both the GON and the applicants. While testing must be accomplished prior to accession to the military, it is voluntary to join. Previously, counseling and results were not necessarily provided to the applicants (inability to follow up, non availability of confirmatory testing). In this manner, applicants will be counseled, and if found to be positive, will be counseled and referred to the nearest ART facility for evaluation. Data collection will provide critical, prevalence information in the military eligible population, and will supplement other HIV prevalence mechanisms. Support will expand in 2006 to introduce formal pre- and post-test counseling for all individuals (to include links to prevention programs) as well as develop formal referrals to treatment facilities.

Funding will support training, and refresher training, of 140 NMOD staff and volunteers, including PLWHA, in counseling and testing, mainly through local, site-based programs and in conjunction with other partners and agencies, using the national curriculum. Clinic renovations to ensure privacy, community outreach, and development of standardized referral system will supplement present activities. RTKs, provided by PEPFAR funded SCMS, consumables and sterile venepuncture items (provided by DOD) will ensure all sites

have sufficient supplies. SCMS will provide a point of service (PoS) supply to all sites, assuming full responsibility for all aspects of the chain with a small buffer stock maintained in country to protect against unforeseen shortages. Capacity developed under ARV drugs for forecasting and procurement will be built upon to support additional consumable needs.

By training uniformed members and civilian employees that are invested in a career track in the Government of Nigeria, this Program fosters a generation of skilled workers who are more likely to remain within the military. As these employees are promoted, individuals not only acquire technical skills, but also gain management and oversight capacity fulfilling PEPFAR goals for independent and sustainable programs.

Monitoring and evaluation of service quality, together with a formal quality improvement mechanism, which includes quarterly site visits by NMOD/DOD consultant teams and appropriate partners, are essential components of this program (more frequent visits during start-up).

By the end of COP07, the DoD will support 14 NMoD sites in Benin, Benue, Borno, Cross Rivers, Delta, Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, and Rivers (11 states and FCT).

Contribution To Overall Program Area

The DoD VCT service will enable the identification of HIV positive individuals in an efficient and timely manner and feed into the care and treatment services for both HIV and HIV/TB, contributing to the target of 3,610 new patients on ART in COP07. In addition, the VCT services will add to the prevention strategies of averting new infections through efficient and effective post-test counseling and education.

Links To Other Activities VCT activities will be linked to prevention services (3.3.01, 3.3.02, 3.3.05), ART services (3.3.11), care and support (3.3.06), TB/HIV (3.3.07), PMTCT (3.3.01), OVC (3.3.08), and strategic information (3.3.13) and will support other partners, including the GoN, in delivering quality, integrated services.

Populations Being Targeted

This activity targets the military, civilian employees, dependents and the general population surrounding 14 NMoD sites and in particular TB and other STI infected individuals. By networking with decentralized, community-based services, this activity will reach a wider range of individuals unwilling, or unable, to access services provided in more traditional settings.

Key Legislative Issues Addressed

The expansion of free VCT services to additional sites and community settings will provide service access to underserved communities and individuals and help ensure that HIV+ people are identified and linked to ART services. This will help raise community awareness, increase gender equity, address male norms and behaviours, and reduce stigma and discrimination associated with HIV and AIDS. VCT data collection and analysis will contribute to improving data at the national level

Emphasis Areas

This activity has major emphasis on capacity development and minor emphasis on training, community mobilisation, quality assurance and links with other services and partners.

ACTIVITY DESCRIPTION

This activity is linked to ARV services (#6798 and #6807), Strategic Information (#6800) and Other Policy/System Strengthening (#6809).

COP05 PEPFAR funding supported the opening of four facilities: Defence Headquarters Medical Center (Abuja), 44 Nigerian Army Reference Hospital (Kaduna), Navy Hospital (Ojo, Lagos), 445 Nigerian Air Force Hospital (Ikeja, Lagos). During 2006, the partnership is commencing activities at three facilities: 45 Nigerian Air Force Hospital (Makurdi), 3 Division Nigerian Army Hospital (Jos), and Navy Medical Centre (Calabar). COP 2007 plans expansion to seven new facilities (Naval Medical Centre (Warri), Military Hospital (Benin), 355 Nigerian Air Force Hospital (Jos), 82 Division Nigerian Army Hospital, (Enugu), Military Hospital (Port Harcourt), 2 Division Nigerian Army Hospital (Ibadan), and the Military Hospital (Maiduguri).

As part of the introduction of treatment at each facility in 2005 and 2006, pharmacy assessments and subsequent improvements have or will be completed, including capacity development through the training of the pharmacists and undertaking renovations for pharmacy stores and dispensing units. In 2006, development of capacity of the NMOD (Nigerian Ministry of Defence) to eventually house, manage and distribute ARVs procured by the USG was initiated through the training of a "lead" logistics team and, with the Supply Chain Management System (SCMS), the implementation of quantification tool and tracking system for accountability purpose. In 2007, activities under this submission will continue to guarantee long-term sustainability by ensuring that the necessary infrastructure, systems and technical skills are in place for efficient forecasting, ordering, warehousing, distribution and management of quality ARVs at the 14 NMOD sites as well as at the central level procurement office of the NMOD.

New sites selection is a process undertaken by the USMHRP (United States Military HIV Program) in partnership with the NMOD. Where appropriate, other USG and NMOD partners participate in selection of sites which include criteria such as, inter alia, market characteristics, community support/need for services, manpower availability/needs, security and physical infrastructure. Once selected, NMOD-DOD will conduct a thorough assessment to support treatment, including the pharmacy and stores. This evaluates current staffing, staff skills/education/experience, as well as a full review of existing infrastructure.

Pharmacy training activities are under development, and will include all aspects of drug management, dispensing and housing. At this time, pharmacists are instructed in National treatment guidelines and Standard Operating Procedures (SOPs) on security, quality control and storage. As with clinicians trained in ART, pharmacists who have been trained and have been supporting treatment at facilities operating since 2005 will be sent to new facilities in the initial phases of operation to provide mentoring and ensure continuity of services among military facilities. Continued site support will be conducted using these preceptors as a central pharmacy Quality Assurance (QA)/ Quality Control (QC) team is developed over 2006-2007.

Where necessary, infrastructure improvements are undertaken to ensure the best use of resources through leveraging counterpart funding of the NMOD and through competitive tendering. Pharmacies at the point of drugs dispensing are modeled to provide ease of service for the patient to allow adherence counseling as well as safe storage of the drugs within the dispensing unit. Proper housing for drugs at sites, including A/C with thermostat controls, proper refrigeration and locked storage are instituted. Back up power supplies to ensure proper temperature for cold chain dependent drugs are installed.

Monitoring and evaluation of service quality with a formal quality improvement mechanism, regular site visits by the NMOD/DOD & appropriate partners, and eventually a central NMOD pharmacy QA/QC staff are essential components of this Program. The Program also looks to adapt what SCMS will put in place as a consistently applied quality control and assurance mechanism along the supply chain across all PEPFAR supported countries and partners.

The NMOD-DOD Program will continue to utilize the SCMS for drug acquisition. This

method of drug procurement adheres to USG, Federal Ministry of Health (FMOH) and National Agency for Food and Drug Administration and Control (NAFDAC) policies, guidelines and requirements as well as National Treatment guidelines. Funding under the SCMS award through USAID in the amount of $2.87m will provide quality ARV drugs during COP07 year to treat a total of 4,900 adults and 540 pediatric patients (overall total of 5,440 patients) under the NMOD-DOD program. SCMS will make sure NAFDAC registration and/or waivers are in place and manage all port clearance and initial warehousing and distribution to the NMOD-DOD sites. When possible, the Program will continue to utilize generic drugs and add additional generics as such drugs are FDA approved or tentatively approved. In addition DOD will support coordination for utilization of ARVs provided by the GON or Nigerian Air Force at DOD supported sites.

Funding under this submission will directly support training of pharmacist in forecasting, ordering, record maintenance and proper drug storage,. It will also cover the renovation (at various levels) of 7 pharmacies to improve safety and storage conditions for ARVs. Support for overall NMOD logistics system will also be included covering capacity of the central procurement operations, including ongoing in-service training on a NMOD/national level and introduction of logistics management tools for tracking and maintaining adequate stock levels, as well as required infrastructure for adequate warehousing of drugs prior to distribution to hospitals at a planned central site facility (site to be determined). Currently management is conducted by the DOD, but as the NMOD capacity develops, responsibility will be transitioned to the NMOD. DOD will continue to support and participate in the harmonization process led by the GON with regard to Logistic Management Information System (LMIS) and Inventory Control System (ICS).

By the end of COP07, the DOD will support 14 NMoD sites in Benin, Benue, Borno, Cross Rivers, Delta, Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, and Rivers (11 states and FCT).

CONTRIBUTION TO THE OVERALL PROGRAM AREA DOD activities will contribute to the effective and efficient management of the ARV services and to the Emergency Plan's goal of providing life-saving antiretroviral treatment to more than 350,000 individuals.

LINKS TO OTHER ACTIVITIES This activity will directly link with ART Services (3.3.11). The DoD will continue to collaborate with other PEPFAR implementing partners for information sharing on procurement mechanisms and for sharing of supplies when necessary (3.3.13). The DoD will continue to support systems strengthening and capacity building (3.1.14) in the NMoD.

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 LEGISTLATIVE ISSUES ADDRESSED None

EMPHASIS This activity has major emphasis on commodity procurement and minor emphasis on capacity development, infrastructure development, logistics, and quality assurance/ improvement.

ACTIVITY DESCRIPTION This activity also relates to activities in VCT (#6796), PMTCT (#6801), Basic Care and Support (#6802), OVC (#6808) and TB/HIV (#6795) activities. The Nigerian Ministry of Defense - US Department of Defense (NMOD-DOD) HIV partnership enters its third year in implementing PEPFAR activities. The US Military HIV Research Program (USMHRP), under the DOD, directly implements with its counterpart, the Nigerian Military, ensuring direct capacity building within an Agency of the Federal Government of Nigeria. Through this partnership, the impact of this program in Nigeria is profound on multiple levels: developing a strong USG relationship with another branch of the Nigerian Government; building capacity of the indigenous partner through joint implementation of activities; and offering a cost effective model for implementation through a direct USG-GON collaboration, and supporting both the military and civilian communities, as 80% of patients under ART at military facilities are civilian. The relationship fostered by PEPFAR and DOD/USMHRP has resulted in an excellent partnership with the NMOD. The Program is governed by a Steering Committee, co-chaired by the Minister of State for Defence (MOSD) and the US Ambassador to Nigeria. The MOSD has directed the Emergency Plan Implementation Committee to harmonize with all other partners and funding streams of the Nigerian Military to ensure complete synergy among programs and the coordinated/complementary use of resources. COP 2005 PEPFAR funding supported the opening of four facilities: Defence Headquarters Medical Center (Abuja), 44 Nigerian Army Reference Hospital (Kaduna), Navy Hospital (Ojo, Lagos), 445 Nigerian Air Force Hospital (Ikeja, Lagos). During 2006, the partnership is commencing activities at three facilities: 45 Nigerian Air Force Hospital (Makurdi), 3 Division Nigerian Army Hospital (Jos), and Navy Medical Centre (Calabar). COP 2007 plans expansion to seven new facilities (Naval Medical Centre (Warri), Military Hospital (Benin), 355 Nigerian Air Force Hospital (Jos), 82 Division Nigerian Army Hospital, (Enugu), Military Hospital (Port Harcourt), 2 Division Nigerian Army Hospital (Ibadan), and the Military Hospital (Maiduguri). By training uniformed members and civilian employees that are invested in a career track in the Government of Nigeria, DoD fosters a generation of trained workers who are more likely to remain with the Military for the long term. As these employees are promoted, individuals are not only technically trained, but also receiving management and oversight capability strengthening. In COP07, through an appropriate site-specific network model and in conjunction with other partners, to ensure leverage of resources available to other partners (for example the Government of Nigeria (GoN) and PEPFAR Implementing Partners (IPs), comprehensive ART services will be expanded to recruit 4,210 new patients, maintain 1,830 to reach a total of 6,000 patients, of which 600 (10%) will be paediatric. Sustainability is a fundamental principle of the DoD program, based on human resources, infrastructure development, and health-system strengthening. The DoD will continue to bolster NMoD health systems through training and development in a variety of settings (out-of-country, centralized and on-site) and, with other partners, infrastructure development, and improvements in the health management information system (HMIS). The DoD will assist the NMoD in improving the overall program management, budgeting and financial management, and with the integration of ART into existing health services. In COP07, the DoD will train, through out-of-country (Infectious Diseases Institute, Makere University, Uganda), centralized (Nigerian military developed curriculum) and on-site training, an additional 84 healthcare workers, including doctors, pharmacists, nurses and community workers, and volunteers, including PLWHA, in counseling, testing, ART clinical care, treatment adherence and laboratory monitoring. Adherence counseling for ARVs and instruction in side effects and contra-indications is part of the NMOD internal ART course and each pharmacist is provided with initial and refresher training through this course. Remuneration is not a feature of this program. Additional staff, such as the use of National Youth Service Corps (NYSC), is jointly funded by the DoD and NMoD programs, with planning by the NMoD to assume total coverage of these salaries. Use of the NYSC (usually three to four per site) provides a dual purpose of training young physicians in Nigeria and exposing them to the military system for possible accession to the uniformed services or as NMoD civilian providers. Monitoring and evaluation of service quality, together with a formal quality improvement mechanism, which includes regular site visits by DoD/NMoD, supported by the DoD centrally-employed specialist and in close cooperation with DOD HQ TA and appropriate partners, are essential components of this program. The program harmonizes the FMoH and Nigerian Air Force Programs with the PEPFAR-supported program by providing the same benefits as the PEPFAR program (small number of indirects, approximately 200 in total). All services are at no cost. Patients will generally be followed three times a year, as appropriate. Adherence counselors and local support groups will be utilized to ensure compliance. A

feature of the military is the general stability of the population, as well as the civilian population surrounding the bases. Counseling for HIV+ patients is a feature built into care and support, and continues to be emphasized under the drug therapy program. The program will establish networks of community volunteers, including PLWHAs. Networks will be created to ensure cross-referrals and sharing of best practices between DoD and NMoD, and other implementing partners. The DoD will continue to work with the GoN and other national stakeholders to develop networks for purposes of addressing future sustainability issues and ensuring that the goal of expanding free ARV care to more persons living with HIV/AIDS is accomplished in a sustainable and cost-effective manner. By the end of COP07, the DoD will support 14 NMoD sites in Benin, Benue, Borno, Cross River, Delta, Enugu, the Federal Capital Territory (FCT), Kaduna, Lagos, Oyo, Plateau, and Rivers (11 states and FCT). CONTRIBUTION TO PROGRAM Expansion of ARV services will contribute 1.5% of the overall 2007 PEPFAR targets for Nigeria. The training of health care workers and community volunteers during COP07 will be in keeping with the strategy of human resource development to ensure the sustained delivery of high quality ART services in Nigeria. LINKS TO OTHER ACTIVITIES The ART services will be linked to VCT (#6796), PMTCT (#6801), Basic Care and Support (#6802), OVC (#6808) and TB/HIV (#6795) activities. All NMoD sites will be supported to routinely counsel and test patients that access general medical care at the center. POPULATIONS TARGETED The ART services will target all people in the 14 military communities served, and the civilian population in the surrounding communities, diagnosed as HIV+ and clinically assessed as suitable for treatment. KEY LEGISTLATIVE ISSUES ADDRESSED The ART services will focus on gender issues, through seamless PMTCT/ART/TB services in NMoD sites and in collaboration with neighboring PMTCT sites and in improving women's access to services, particularly in previously underserved communities. Wrap-around issues are also addressed through links with reproductive health services. EMPHASIS This activity will include major emphasis on capacity development and minor emphasis on infrastructure development, linkages with other sectors, quality assurance and improvement, and development of networks, /linkages/referral systems.

Activity Description: Activity ID: 6799; 6806 This activity also relates to activities in ART treatment (6798; 6807), Care and Support (6802), PMTCT (6801), Counseling and Testing (6796), Blood Safety (6805), TB/HIV (6795), OVC (6808) and Strategic Information (6800) The relationship fostered by PEPFAR and DOD/USMHRP has resulted in an excellent partnership with the Nigerian Ministry of Defense (NMOD). The Program is governed by a Steering Committee (SC), co-chaired by the Minister of State for Defence (MOSD) and the US Ambassador. The Emergency Plan Implementation Committee (EPIC), subordinate to the SC, is comprises NMoD and DoD members and directs the implementation of the Program through daily collaboration.

COP 2005 PEPFAR funding supported the opening of four facilities: Defence Headquarters Medical Center (Abuja), 44 Nigerian Army Reference Hospital (Kaduna), Navy Hospital (Ojo, Lagos), 445 Nigerian Air Force Hospital (Ikeja, Lagos). During 2006, the partnership is commencing activities at three facilities: 45 Nigerian Air Force Hospital (Makurdi), 3 Division Nigerian Army Hospital (Jos), and Navy Medical Centre (Calabar). COP 2007 plans expansion to seven new facilities (Naval Medical Centre (Warri), Military Hospital (Benin), 355 Nigerian Air Force Hospital (Jos), 82 Division Nigerian Army Hospital, (Enugu), Military Hospital (Port Harcourt), 2 Division Nigerian Army Hospital (Ibadan), and the Military Hospital (Maiduguri).

Supporting treatment roll out, the NMOD/DOD is working to develop and maintain quality diagnostic and medical laboratory monitoring for HIV+ patients. In 2005 and 2006, seven laboratories have been developed, upgraded and supplied with standardized equipment to provide quality patient service. BD FACSCounts, Vitros chemistry analyzers, Coulter Hematocytometers and microscopes have been purchased for each of the four initial sites. These devices will harmonize with equipment in Nigerian and USMHRP partner laboratories. DoD will continue to work with the GoN and USG partners in developing a common equipment platform. The development of 7 laboratories in 2007 continues this successful element of the NMOD/DOD program. Assessments of the new sites are currently being conducted by a combined NMOD/DOD team to determine infrastructure requirements, including power and water needs, as well as develop layouts for new equipment for hematology, chemistry and CD4 monitoring to be provided under this funding. The development of a centre of excellence in laboratory practice and HIV and TB diagnostics will continue.

An additional 70 Laboratorians will be trained, in a variety of settings, including centralized partner facilities (e.g. Asokoro and Jos) and site-level facilities, during COP07. Laboratorians are critical in supporting all program areas and the process of selecting 2 staff from each new lab to receive intensive 3 week training at the MRMC in Uganda will continue. This military-military training provides excellent results as well as building rapport with staff from both the US and other African countries. Continuing education has been initiated by the partnership with 445 NAF Hospital utilized as a central training facility, with staff attending for training in Standard Operating Procedures (SOPs), equipment-specific training and safety training. This is followed by using military "consultants", who visit each site to provide training in quality control. SOPs, QA/QC procedures and consultant roles are provided by both direct DOD TA, OGAC TA, and planned links to CDC and CDC partners that will optimize resources and strengthen the comprehensive networks of care across all sites, including centralized laboratory training and establishing high level laboratory services for pediatric diagnosis (using DBS for specimen collection). Lastly, the DOD utilises quarterly internal monitoring and QA/QC using these internal consultant teams (Nigerian Laboratory officers from other facilities) and external teams (USMHRP and other partners), supported by the DoD centrally-employed laboratory specialist and in close cooperation with, and input from, DOD HQ TA.

This substantial training of uniformed members and civilian employees that are invested in a career track in the Government of Nigeria creates a generation of skilled workers who are more likely to remain within the military. As these employees are promoted, individuals not only acquire technical skills, but also gain management and oversight capacity fulfilling PEPFAR goals for independent and sustainable programs.

Through this activity, DOD will provide support in HIV diagnostics, CD4 determination,

hematology, opportunistic infections and good laboratory practices. These full service sites will carry out 150,000 tests for ART, PMTCT, TB, OVC and blood safety in order to diagnose and provide ART to at least 3,610 new patients while diagnosing and providing ART to 540 (10%) children and serving over 4,800 PMTCT clients. This activity will support ART, TB and OI monitoring tests for 5,440 patients on ARVs and another 14,480 on palliative care.

A secure supply chain, for reagents and other consumable items, to all laboratories will be initially be provided by DOD with plans to move to Supply Chain Management Systems (SCMS). This will ensure all sites have sufficient consumables and supplies, including all reagents and most lab consumables. SCMS will provide a point of service (PoS) supply to all sites, assuming full responsibility for all aspects of the chain with a small buffer stock of critical items maintained in country to protect against unforeseen shortages.

This program fully adheres to USG policies and acquisition regulations, minimizes indirect costs to accomplish the capacity building described above. International and local organizations synergize with the Nigerian Ministry of Defense to identify best practices and implement evidence based interventions in a sustainable manner. The program design ensures continued USG visibility and accountability at all levels of implementation.

By the end of COP07, the DoD will support 14 NMoD sites in Benin, Benue, Borno, Cross River, Delta, Enugu, the Federal Capital Territory (FCT), Kaduna, Lagos, Oyo, Plateau, and Rivers (11 states and FCT).

Contribution To Overall Program Area

Through this activity, DoD will provide training and support in HIV diagnostics, CD4 determination, hematology, opportunistic infections and good laboratory practices. These full service sites will carry out 150,000 tests for ART, PMTCT, OVC and blood safety in order to diagnose and provide ART to at least 3,670 new patients while diagnosing and providing ART to 330 (9%) children and serving over 9,750 PMTCT clients. This activity will support ART and OI monitoring tests for 5,400 patients on ARVs and another 13,700 on palliative care.

Links To Other Activities: Links will be created with other implementing partners to optimize resources and strengthen the comprehensive networks of care across all sites, including centralized laboratory training and establishing high level laboratory services for pediatric diagnosis.

Populations: This activity targets the military, civilian employees, dependents and the communities surrounding military sites. In particular, PLWHAs, orphans and vulnerable children, HIV+ pregnant women and HIV+ infants will be targeted. Further specific targets will be co-infected individuals for TB and STIs.

Key Legislative: Support to laboratory infrastructure will impact on gender issues by improving equitable access to efficient and cost-effective services, some in previously under-served areas and wrap around by developing linkages with other sectors (such as reproductive health).

Emphasis Areas: This activity involves major emphasis on infrastructure development and minor emphasis on training, commodity procurement, capacity development, and quality assurance and improvement.

ACTIVITY DESCRIPTION Strategic Information activity relates to all prevention activities: PMTCT (#6801), Abstinence/Be Faithful (#6803), Condom and Other Prevention (#6805); HIV/AIDS/TB Treatment and Care Services: HIV-TB (#6795), OVC (#6808), ARV Drugs (#6797), ARV Services (#6798); palliative care services: (#6802), TB/HIV (#6795), OVC (#6808) and Laboratory Infrastructure (#6806).

The Nigerian Ministry of Defence - US Department of Defense (NMOD-DOD) HIV partnership enters its third year in implementing PEPFAR activities. The US Military HIV Research Program (USMHRP), under the DOD, directly implements with its counterpart, the Nigerian Military. Implementation in this manner ensures direct capacity building within an Agency of the Federal Government of Nigeria. Through this partnership, the impact of this program in Nigeria is profound on multiple levels- developing a strong USG relationship with another branch of the Nigerian Government; building capacity of the indigenous partner through joint implementation of activities; and offering a cost effective model for implementation through a direct USG-GON collaboration, and supporting both the military and civilian communities, as 80% of patients under ART at military facilities are civilian.

FY2005 saw opening of four facilities at Defence Headquarters Medical Center (Abuja), 44 Nigerian Army Reference Hospital (Kaduna), Navy Hospital (Ojo-Lagos), and 445 Nigerian Air Force Hospital (Ikeja-Lagos). During 2006, the DoD-NMoD partnership is commencing activities at three facilities: 45 Nigerian Air Force Hospital (Makurdi), 3 Division Nigerian Army Hospital (Jos), and Navy Medical Centre (Calabar). The 2007 budget will see expansion to seven additional facilities: Naval Medical Centre (Warri); Military Hospital (Benin), 355 Nigerian Air Force Hospital (Jos), 82 Division Nigerian Army Hospital, (Enugu), Military Hospital (Port Harcourt), 2 Division Nigerian Army Hospital (Benin), 2 Div Hospital (Ibadan). Information strengthening will be improved at the Emergency Plan Implementation Committee and Ministry of Defence Headquarters.

The Nigerian Military provides care to its service members and the surrounding civilian community (over 80% of the Military's patient load is civilian). This Strategic Information (SI) activity incorporates program-level reporting and the establishment of both paper-based and computerized Health Management Information Systems (HMIS) across Nigerian Ministry of Defence (NMoD) sites, in support of designing and implementing high quality, sustainable, evidence-based interventions and programs. This activity will support ARV treatment, VCT, PMTCT and TB/HIV services at 14 sites an, as a result, 17 organizations will be provided with Technical Assistance. All activities will be in line with GoN SI harmonization policies and guidance.

This activity will support the use of networking infrastructure by providing computer hardware, operating system software and applications, and networking equipment (patient registration, clinic, pharmacy, laboratory, administrative, generally 4-6 computers per site). 25 staff are being trained in COP06 and the DoD will train, in centralized and site-specific settings, at least 122 additional NMoD staff across 14 sites and 3 central organizations in the management and maintenance of the PMM system on issues such as data entry, analysis, data management and quality assurance.

By training uniformed members and civilian employees at all levels that are invested in a career track in the Government of Nigeria, this Program fosters a generation of skilled workers who are more likely to remain within the military. As these employees are promoted, individuals not only acquire technical skills, but also gain management and oversight capacity fulfilling PEPFAR goals for independent and sustainable programs.

The DoD is utilizing existing patient registry (Government of Nigeria-approved) and patient monitoring and management (PMM) systems in all program areas, using simple available and sustainable technology at the eight existing sites and will extend and develop this system to the six new sites in COP07. This system generates a unique PIN number to ensure patient confidentiality whilst supporting patient tracking. As a national unique patient numbering system is introduced, the DoD will ensure harmonization of systems.

The DoD will continue to provide the NMOD with training and technical assistance in confidentiality and data security, data entry, analysis, data management and quality

assurance, and will continue to adapt and harmonize existing paper records to meet the standards of the GoN. The DoD will carry out regular site visits and reviews to ensure quality data and data validation.

The DoD will continue to participate in the relevant working groups in developing and implementing credible and cost-effective SI policies and systems, harmonized with other partners and agencies, in national surveys, and in the regular use of standardized qualitative methodologies for service assessments to ensure a consistent approach across all providers.

Monitoring and evaluation of service quality, together with a formal quality improvement mechanism, which includes regular site visits by the DoD/NMoD, supported by the centrally-employed DoD specialist and appropriate partners, are essential components of this program. Regular use of data (including sharing information on individual sites, programs and partners) as part of the routine management process at all levels (site, organization, PEPFAR Team) will encourage and sustain data quality, and ensure service quality.

This program fully adheres to USG policies and acquisition regulations and minimizes indirect costs to accomplish the capacity building described above. International and local organizations synergize with the Nigerian Ministry of Defense to identify best practices and implement evidence-based interventions in a sustainable manner. The program design ensures continued USG visibility and accountability at all levels of implementation.

By the end of COP07, the DoD will support 14 NMoD sites in Benin, Benue, Borno, Cross Rivers, Delta, Enugu, FCT, Kaduna, Lagos, Oyo, Plateau, and Rivers (11 states and FCT).

CONTRIBUTION TO OVERALL PROGRAM AREA Improvement in SI management capacity, and further staff development and training within the NMoD, EPIC, AFPAC and 14 sites, will ensure effective data use and management, at organizational, work group and individual levels. This activity will contribute towards the GoN and USG strategy for the provision of quality, relevant and timely information for decision-making. This information will serve as an invaluable resource in developing plans that enhance the cost-effectiveness of the operations and management of the NMoD.

LINKS TO OTHER ACTIVITIES Strategic Information activity relates to all prevention activities (#6801, #6803, #6804) HIV/AIDS/TB treatment and care services (#6795, #6808, #6797, #6798), palliative care services (#6802, .#6795, #6808) and Laboratory Infrastructure (#6799).

POPULATIONS BEING TARGETED This activity targets national level policy makers in the military, the GoN and national organizations, such as the National Action Committee on AIDS, as well as community-based organizations, faith-based organizations, and healthcare workers, specifically all staff undertaking data entry, at the national and local levels.

KEY LEGISLATIVE ISSUES ADDRESSED None

EMPHASIS AREAS The DoD SI activities include major emphasis on HMIS and minor emphasis on capacity development, infrastructure, training, and policy and guidelines.

Funding for SI related equiment and supplies in the amount of $100,000 has be placed under SCMS SI for procurement purposes.

This activity relates to ART Services (3.3.11), ART Drugs (3.3.10), and Strategic Information (3.3.13) program area activities.

The Nigerian Ministry of Defense - US Department of Defense (NMOD-DOD) HIV partnership enters its third year in implementing PEPFAR activities. The US Military HIV Research Program (USMHRP), under the DOD, directly implements with its counterpart, the Nigerian Military. Implementation in this manner ensures direct capacity building within an Agency of the Federal Government of Nigeria. Through this partnership, the impact of this program in Nigeria is profound on multiple levels- developing a strong USG relationship with another branch of the Nigerian Government; building capacity of the indigenous partner through joint implementation of activities; and offering a cost effective model for implementation through a direct USG-GON collaboration, and supporting both the military and civilian communities.

The relationship fostered by PEPFAR and DOD/USMHRP has resulted in an excellent partnership with the NMOD. The DoD PEPFAR Program is governed by a Steering Committee (SC), co-chaired by the Minister of State for Defence (MOSD) and the US Ambassador to Nigeria, whose membership includes representatives of both militaries, the Federal Ministry of Health (FMOH) and National Committee on AIDS Control (NACA)., The Emergency Plan Implementation Committee (EPIC), subordinate to the SC, is comprised of Nigerian and US Military members and directs the implementation of the Program through daily contact. The MOSD has directed the EPIC to harmonize with all other partners and funding streams of the Nigerian Military to ensure complete synergy among programs and the coordinated/complementary use of resources.

COP 2007 plans expansion to seven new facilities: (Naval Medical Centre (Warri), Military Hospital (Benin), 355 Nigerian Air Force Hospital (Jos), 82 Division Nigerian Army Hospital, (Enugu), Military Hospital (Port Harcourt), 2 Division Nigerian Army Hospital (Ibadan), and the Military Hospital (Maiduguri).

Cost effectiveness for this program is without question. This program fully adheres to USG policies and acquisition regulations, minimizes indirect costs, and accomplishes the capacity building described above. International and local organizations may synergize with the Nigerian Ministry of Defence and identify best practices and implement evidence based interventions in a sustainable manner. This ensures continued USG visibility at all levels of implementation. The NMOD-DOD HIV partnership in implementing PEPFAR activities is a strong, focused, capacity building execution of the program that ensures a cost effective, sustainable program.

DoD will focus primarily on supporting the NMoD in developing, implementing and reviewing policies on reducing the incidence and prevalence of HIV/AIDS in military communities and in strengthening its systems and capacity building. Additionally, the DoD will continue to be involved with all its PEPFAR partners in their policy and system strengthening and harmonisation activities. A product of this will be funding proposals to NACA, The Gates Foundation and the US European Command.

Within the military community, DoD activities will include further support for policy and systems strengthening activities, and the provision of training and development for the Nigerian Ministry of Defence (NMoD). Support to the three target organizations, (NMOD, EPIC and the Armed Forces Program on AIDS Control), will include addressing high risk issues such as peacekeeping and other extra-country deployments as well as internal deployments.

Specific interventions at 14 sites will include mobilization of local military communities to address male norms and behaviors regarding cross-generational and transactional sex and support for the development of military policy to prevent sexual violence and coercion. CBOs will be strengthened in their efforts to reduce the stigma associated with HIV status and to reduce discrimination faced by those with HIV or AIDS.

Externally, the DoD will continue to develop its support for military coordination activities, particularly within Africa, building on relationships developed during the PEPFAR Conference in Durban 2006, and will, as a consequence, support policy development and systems strengthening activities, including training and other learning experiences, and

contacts and exchanges with appropriate military organizations. Exchange opportunities with the South African, Kenyan and Ghanaian militaries will be explored. Specific products expected from these activities will be enhanced policies on pre and post deployment peacekeeping testing and a study of the manpower required for maintaining treatment activities started with PEPFAR funding in the post-PEPFAR era thus ensuring sustainability.

At the local level the DoD will support training and development activities for 168 individuals at 14 sites, in centralised and site-specific settings, targeted at individual and work-group development in management, budgeting, logistics, project planning, implementation, and monitoring and evaluation. By training uniformed members and civilian employees at all levels that are invested in a career track in the GoN, we foster a generation of trained workers who are more likely to remain with the Military for the long term. As these employees are promoted, individuals are not only technically trained, but also receiving management and oversight capability strengthening. This clearly fulfills PEPFAR program goals for independent operation and oversight roles.

Within Nigeria, in addition to its commitment to the PEPFAR Team and its technical working groups concerning policy and guideline development, the DoD will continue to be involved with organizations responsible for responding to the HIV/AIDS epidemic in their national policy development, implementation and coordinating activities. These organizations include the FMoH, NACA, the National Committee on AIDS/STD Prevention, and the Global Fund.

The DOD activities are designed to develop and strengthen policies and systems that facilitate improved delivery of high quality healthcare to people infected and affected by HIV/AIDS. This will, in turn, facilitate greater coordination and harmonisation across all sectors, improve involvement and commitment and ensure long-term sustainability.

These DoD activities are linked to all other program areas by ensuring the development of policies and systems that ensure cost-effective service delivery in a coordinated and harmonized manner, by PEPFAR partners and Implementing Partners (IPs), the Government of Nigeria (GoN) and other bi-and multi-lateral partners.

Whilst the primary target of these activities is the Nigerian Military, the impact will be felt by all sectors within Nigeria in supporting coordinated and harmonized service delivery. Beyond the military, targeted populations will include host country government workers, CBOs, FBOs the CCM, implementing organizations, and community and religious leaders, mainly to assist with policy development. Training will be provided, in conjunction with other partners (PEPFAR and GoN), in systems strengthening, community mobilisation, and service evaluation.

Due to the inclusive nature of these activities, all aspects of HIV/AIDS policies and guidelines and, hence, all aspects of legislation are affected. There will, however, be more emphasis placed on gender issues, such as addressing male norms and behaviours, and on reducing stigma and discrimination.

This activity includes major emphasis on policy and guidelines and minor emphasis on local organization capacity development, strategic information, training and linkages with other sectors and initiatives.